Provider Demographics
NPI:1861401333
Name:RICARDO POCURULL, PA
Entity type:Organization
Organization Name:RICARDO POCURULL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:POCURULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:979-696-8000
Mailing Address - Street 1:1721 BIRMINGHAM DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4081
Mailing Address - Country:US
Mailing Address - Phone:979-696-8000
Mailing Address - Fax:979-696-8100
Practice Address - Street 1:1721 BIRMINGHAM DR
Practice Address - Street 2:SUITE 204
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4081
Practice Address - Country:US
Practice Address - Phone:979-696-8000
Practice Address - Fax:979-696-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK-2776207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165453501OtherMEDICAID DME
TX0048QNOtherBCBS GROUP ID
TX152067801Medicaid
TX660003931OtherMEDICARE RAILROAD
TX0048QNOtherBCBS GROUP ID
TXH25739Medicare UPIN
TX152067801Medicaid