Provider Demographics
NPI:1164581609
Name:RUBEN D BOCANEGRA MD PA
Entity Type:Organization
Organization Name:RUBEN D BOCANEGRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOCANEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-724-2800
Mailing Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY
Mailing Address - Street 2:STE 101-B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4741
Mailing Address - Country:US
Mailing Address - Phone:956-724-2800
Mailing Address - Fax:956-724-4167
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:STE 101-B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-724-2800
Practice Address - Fax:956-724-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00720UMedicare PIN
TXDA1448Medicare PIN
TX8A3636Medicare PIN
TXG08030Medicare UPIN