Provider Demographics
NPI:1689966780
Name:PEDRAZA, RUBEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:PEDRAZA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3156
Mailing Address - Country:US
Mailing Address - Phone:361-800-8155
Mailing Address - Fax:361-882-2590
Practice Address - Street 1:917 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2301
Practice Address - Country:US
Practice Address - Phone:361-883-1879
Practice Address - Fax:361-883-1881
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9480207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist