Provider Demographics
NPI:1821083502
Name:AZOCAR, RUBEN J (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:J
Last Name:AZOCAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 BROOKLINE AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5491
Mailing Address - Country:US
Mailing Address - Phone:617-667-3110
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5491
Practice Address - Country:US
Practice Address - Phone:617-667-3110
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0150096Medicaid
H49849Medicare UPIN
MA0150096Medicaid