Provider Demographics
NPI:1790754497
Name:BRAZA, RUDY MAEDA (MD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:MAEDA
Last Name:BRAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5667
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-5667
Mailing Address - Country:US
Mailing Address - Phone:903-223-1014
Mailing Address - Fax:
Practice Address - Street 1:4102 RICHMOND MDWS
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0067
Practice Address - Country:US
Practice Address - Phone:903-223-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN72322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology