Individual
DR. RICHARD BRUCE DEBENEDETTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2217 PADRE BLVD, SOUTH PADRE ISLAND, TX 78597
(956) 761-4649
(866) 594-1025
Mailing address
2217 PADRE BLVD, SOUTH PADRE ISLAND, TX 78597
(956) 761-4649
(866) 594-1025
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
J9579
TX
207R00000X
Internal Medicine Physician
J9579
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113326621
—
TX
01
—
8CE910
BCBS
TX
Enumeration date
02/28/2006
Last updated
10/03/2013
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