Individual
GRACE RUIDERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 N POST RD, SUITE C, MIDWEST CITY, OK 73130-3605
(405) 455-4342
(405) 455-4381
Mailing address
PO BOX 776066, CHICAGO, IL 60677-6066
(405) 455-4342
(405) 455-4381
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19279
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100035440B
—
OK
Enumeration date
07/04/2006
Last updated
11/12/2018
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