MEDICARE: DR. RICHARD BRUCE DEBENEDETTO 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	J9579	TX
2	207R00000X	Internal Medicine Physician	J9579	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CE910	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8CE910	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1679549513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD BRUCE DEBENEDETTO M.D.

Provider Business Mailing Address
First Line	:	2217 PADRE BLVD
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597
Country	:	US
Telephone Number	:	956-761-4649
Fax Number	:	866-594-1025

Provider Business Practice Location Address
First Line	:	2217 PADRE BLVD
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597
Country	:	US
Telephone Number	:	956-761-4649
Fax Number	:	866-594-1025

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	10/03/2013

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Directions to “ DR. RICHARD BRUCE DEBENEDETTO M.D.” Practice Location

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