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General NPI Number Information
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NPI Number | 1164581609
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Entity Type | Organization
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Legal Business Name | RUBEN D BOCANEGRA MD PA
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 4151 JAIME ZAPATA MEMORIAL HWY STE 101-B
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City | LAREDO
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State | TX
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Zip | 78043-4741
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Country | US
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Telephone | 956-724-2800
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Fax | 956-724-4167
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Provider Business Mailing Address
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Address Line | 4151 JAIME ZAPATA MEMORIAL HWY STE 101-B
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City | LAREDO
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State | TX
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Zip | 78043-4741
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Country | US
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Telephone | 956-724-2800
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Fax | 956-724-4167
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Authorized Official
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Title or Position | OWNER
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Name | MR. RUBEN D BOCANEGRA
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Credential | MD
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Telephone | 956-724-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J8919
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License Number State | TX
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