Provider Demographics
NPI:1821207044
Name:RUIZ, JILL P (MD)
Entity type:Individual
Prefix:PROF
First Name:JILL
Middle Name:P
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:P
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:5125 TEXOMA MEDICAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-0084
Practice Address - Country:US
Practice Address - Phone:903-868-4700
Practice Address - Fax:903-892-4910
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018121390200000X
TXN63492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200311330AOtherOKAHOMA MEDICAID
TX214144202Medicaid
TX214144201Medicaid
TXP00942262OtherMEDICARE RAILROAD
TX214144201Medicaid
TXTXB124056Medicare PIN