Provider Demographics
NPI:1972699627
Name:SUNGA, RUBEN L JR (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:L
Last Name:SUNGA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1816 SUNSET PARK TER
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3599
Mailing Address - Country:US
Mailing Address - Phone:580-319-1391
Mailing Address - Fax:580-319-4004
Practice Address - Street 1:731 12TH AVE NW
Practice Address - Street 2:STE 301
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5761
Practice Address - Country:US
Practice Address - Phone:580-319-1391
Practice Address - Fax:580-319-4004
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK6351207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144013303Medicaid
TX144013303Medicaid
TX8344K2Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER