Provider Demographics
NPI:1235363433
Name:SOBREVILLA, JOSE RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RICARDO
Last Name:SOBREVILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4302 S SUGAR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9140
Mailing Address - Country:US
Mailing Address - Phone:956-388-2700
Mailing Address - Fax:956-388-2710
Practice Address - Street 1:4302 S SUGAR RD STE 101
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9140
Practice Address - Country:US
Practice Address - Phone:956-388-2700
Practice Address - Fax:956-388-2710
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP2066207Q00000X, 208M00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309360103Medicaid
TX415040ZPGVOtherMEDICARE LINKED TO J RICARDO SOBREVILLA MD PLLC
TXP01835138OtherRR MEDICARE
SC309360101Medicaid