MEDICARE: DR. RUBEN D BOCANEGRA MD

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
1	207Q00000X	Family Medicine Physician	J8919	TX

General Provider Information

NPI Number	:	1205820602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN D BOCANEGRA MD

Provider Business Mailing Address
First Line	:	4151 JAIME ZAPATA MEMORIAL HWY
Second Line	:	STE 101-B
City	:	LAREDO
State	:	TX
Zip	:	78043-4725
Country	:	US
Telephone Number	:	956-724-2800
Fax Number	:	956-724-4167

Provider Business Practice Location Address
First Line	:	4151 JAIME ZAPATA MEMORIAL HWY
Second Line	:	STE 101-B
City	:	LAREDO
State	:	TX
Zip	:	78043-4725
Country	:	US
Telephone Number	:	956-724-2800
Fax Number	:	956-724-4167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	04/29/2022

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