Provider Demographics
NPI:1528337003
Name:RASCON, RICHARD RUEBEN JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RUEBEN
Last Name:RASCON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 WAR BONNET ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3457
Mailing Address - Country:US
Mailing Address - Phone:210-744-4041
Mailing Address - Fax:
Practice Address - Street 1:6106 WAR BONNET ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3457
Practice Address - Country:US
Practice Address - Phone:210-744-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver