Provider Demographics
NPI:1730189218
Name:RUANE, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RUANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-485-3351
Practice Address - Fax:941-485-7677
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0062037208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77215KOtherMEDICARE GROUP
FLP01808695OtherCLEAR HEALTH ALLIANCE
FL4271813OtherAETNA PROVIDER #
FLP00470778OtherRR MEDICARE
FL1096806OtherWELLCARE
FL30421201OtherCITRUS HEALTH
FL344469OtherAVMED
FLF22482Medicare UPIN
FL1096806OtherWELLCARE