Individual
JIMMY RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005-01963
NC
207RH0003X
Hematology & Oncology Physician
Primary
2005-01963
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145JG
BCBS
—
01
—
199209
MEDCOST
—
01
—
2064994
MEDICARE
NC
05
—
3810009019
—
WV
05
—
5906698
—
NC
01
—
810605
PARTNERS
—
01
—
9062063
AETNA
—
05
—
Q01963
—
SC
Enumeration date
04/04/2006
Last updated
05/04/2016
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