MEDICARE: DR. RUBEN CARLOS BANCHS SEDA M.D.

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	208D00000X	General Practice Physician	16508	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16508	OTHER	PR	LICENSE

General Provider Information

NPI Number	:	1205959905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN CARLOS BANCHS SEDA M.D.

Provider Business Mailing Address
First Line	:	3201 PORTALES DEL MONTE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00780-3201
Country	:	US
Telephone Number	:	787-675-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 PORTALES DEL MONTE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00780-2033
Country	:	US
Telephone Number	:	787-675-1952
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	04/04/2014

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