Provider Demographics
NPI:1033191135
Name:COVARRUBIAS, BALDEMAR JR (MD)
Entity Type:Individual
Prefix:
First Name:BALDEMAR
Middle Name:
Last Name:COVARRUBIAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 SPOHN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4235
Mailing Address - Country:US
Mailing Address - Phone:361-980-0808
Mailing Address - Fax:866-239-6612
Practice Address - Street 1:5718 SPOHN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4235
Practice Address - Country:US
Practice Address - Phone:361-980-0808
Practice Address - Fax:361-980-0088
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136778106Medicaid
00J70EMedicare ID - Type Unspecified
B22003Medicare UPIN