MEDICARE: DR. RUBEN PEDRAZA JR. 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	207Q00000X	Family Medicine Physician	N9480	TX
2	208M00000X	Hospitalist Physician	N9480	TX

General Provider Information

NPI Number	:	1689966780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN PEDRAZA JR. M.D.

Provider Business Mailing Address
First Line	:	1660 S STAPLES ST
Second Line	:	STE 150
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-3156
Country	:	US
Telephone Number	:	361-800-8155
Fax Number	:	361-882-2590

Provider Business Practice Location Address
First Line	:	917 S PORT AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-2301
Country	:	US
Telephone Number	:	361-883-1879
Fax Number	:	361-883-1881

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

Provider Enumeration Date	:	05/07/2011
Last Update Date	:	01/31/2017

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