Provider Demographics
NPI:1790882801
Name:VALDES, RUBEN MARCOS (DO)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:MARCOS
Last Name:VALDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7519 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4113
Mailing Address - Country:US
Mailing Address - Phone:813-884-1478
Mailing Address - Fax:813-884-1798
Practice Address - Street 1:7519 PAULA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4113
Practice Address - Country:US
Practice Address - Phone:813-884-1478
Practice Address - Fax:813-884-1798
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0S3207207Q00000X
FLOS0003207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110013728OtherRR MEDICARE
FL33864OtherBLUE SHIELD
FL6525156OtherCIGNA
FL069086400OtherWORKMAN'S COMP
FL4644617OtherAETNA
FL232964OtherWELLCARE
FL069086400Medicaid
FL209545OtherAVMED
FL9326165OtherAETNA GROUP #
FL592746543OtherWELLCARE MEDICARE
FL069086400OtherWORKMAN'S COMP
FL4644617OtherAETNA
FLE32063Medicare UPIN