1649456914 NPI number — MARTIN H RUBIN MD PLLC

Table of content: (NPI 1649456914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649456914 NPI number — MARTIN H RUBIN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN H RUBIN MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649456914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7525 E BROADWAY RD
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85208-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-839-7627
Provider Business Mailing Address Fax Number:
480-839-7643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7525 E BROADWAY RD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85208-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-839-7627
Provider Business Practice Location Address Fax Number:
480-839-7643
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-839-7627

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  AZ12996 , 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: AZ0037030 . This is a "BCBS AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ7216 . This is a "HEALTHNET OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860527535 . This is a "TRICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 226432 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110005756 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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