1528169448 NPI number — MR. SCOTT ALVIN RUBIN M.D.

Table of content: MR. SCOTT ALVIN RUBIN M.D. (NPI 1528169448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528169448 NPI number — MR. SCOTT ALVIN RUBIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
SCOTT
Provider Middle Name:
ALVIN
Provider Name Prefix Text:
MR.
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:
RUBIN
Provider Other First Name:
SCOTT
Provider Other Middle Name:
ALVIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528169448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5440 WEST SAHARA
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-380-8200
Provider Business Mailing Address Fax Number:
702-380-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5440 WEST SAHARA
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-380-8200
Provider Business Practice Location Address Fax Number:
702-380-3220
Provider Enumeration Date:
09/25/2006

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: 2084P0800X , with the licence number:  6160 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002019122 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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