Provider Demographics
NPI:1689697096
Name:BALDEMAR COVARRUBIAS M.D., PA
Entity Type:Organization
Organization Name:BALDEMAR COVARRUBIAS M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-980-0808
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:78414-4116
Mailing Address - Country:US
Mailing Address - Phone:361-980-0808
Mailing Address - Fax:361-653-7041
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:78414-4116
Practice Address - Country:US
Practice Address - Phone:361-980-0808
Practice Address - Fax:361-653-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W265Medicare ID - Type Unspecified
TXB22003Medicare UPIN