Doctor Name: | DR. RUBEN F. VIZCARRA |
NPI Number: | 1255360392 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01022488A |
Business Practice Address: | 1098 S State Road 25 Logansport, IN - 469476723 |
Business Phone Number: | 5747224141 |
Business Fax Number: | 5747353414 |
Mailing Address: | 1098 S State Road 25, LOGANSPORT |
State: | IN |
Postal Code: | 469476723 |
Phone Number: | 5747224141 |
Fax Number: | 5747353414 |
NPI Enumeration Date: | 07/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01022488A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |