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NPI Code Detail

MEDICARE: BENJAMIN RUDDICK, MD, PLLC

MEDICARE: BENJAMIN RUDDICK, MD, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1255275368
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENJAMIN RUDDICK, MD, PLLC
Provider Business Mailing Address
First Line : PO BOX 240098
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78224-0098
Country : US
Telephone Number : 210-621-0640
Fax Number : 210-621-2386
Provider Business Practice Location Address
First Line : 18600 HARDY OAK BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4206
Country : US
Telephone Number : 210-621-0640
Fax Number : 210-621-2386
Authorized Official
Title or Position : OWNER
Name : MR. BENJAMIN RUDDICK
Credential : MD
Telephone Number : 210-621-0640
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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