Basic Information
| Provider Information | |||||||||
| NPI: | 1962778399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | MATHIS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 UNION AVE STE 330 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014780954 | ||||||||
| FaxNumber: | 9014780951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 UNION AVENUE, 4 SHORB TOWER | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014789183 | ||||||||
| FaxNumber: | 9014788957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 4671 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 4671 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA07629 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.