Provider Demographics
NPI:1205820602
Name:BOCANEGRA, RUBEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:D
Last Name:BOCANEGRA
Suffix:
Gender:M
Credentials:MD
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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:78043-4725
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:78043-4725
Practice Address - Country:US
Practice Address - Phone:956-724-2800
Practice Address - Fax:956-724-4167
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-04-29
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Provider Licenses
StateLicense IDTaxonomies
TXJ8919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3636Medicare PIN
TXG08030Medicare UPIN
TX00720UMedicare PIN