MEDICARE: MR. RICHARD RUEBEN RASCON JR.

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	172A00000X	Driver

General Provider Information

NPI Number	:	1528337003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD RUEBEN RASCON JR.

Provider Business Mailing Address
First Line	:	6106 WAR BONNET ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3457
Country	:	US
Telephone Number	:	210-744-4041
Fax Number	:

Provider Business Practice Location Address
First Line	:	6106 WAR BONNET ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3457
Country	:	US
Telephone Number	:	210-744-4041
Fax Number	:

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

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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