1194749341 NPI number — DR. MARK LESLIE RUBIN M.D.

Table of content: (NPI 1225232986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194749341 NPI number — DR. MARK LESLIE RUBIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
MARK
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194749341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11417
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-0024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-284-7304
Provider Business Mailing Address Fax Number:
480-284-7616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 S. MCCLINTOCK DR.#105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-284-7304
Provider Business Practice Location Address Fax Number:
480-284-7616
Provider Enumeration Date:
07/27/2006

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: 2084P0005X , with the licence number:  18801 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 18801 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 18801 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 431982 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194749341 . This is a "NPI" identifier . This identifiers is of the category "OTHER".