1609957059 NPI number — DR. RUBY LYNN ZUBROD CCC A

Table of content: DR. RUBY LYNN ZUBROD CCC A (NPI 1609957059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609957059 NPI number — DR. RUBY LYNN ZUBROD CCC A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUBROD
Provider First Name:
RUBY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CCC A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAFFIN
Provider Other First Name:
RUBY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609957059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-426-4327
Provider Business Mailing Address Fax Number:
307-426-4327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7215 COMMONS CIR
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82009-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-426-4327
Provider Business Practice Location Address Fax Number:
307-638-0394
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  200342 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: A-994 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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