Provider Demographics
NPI:1003825894
Name:GAPPY, RUBIN PETER (MD)
Entity Type:Individual
Prefix:
First Name:RUBIN
Middle Name:PETER
Last Name:GAPPY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:46591 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5742
Mailing Address - Country:US
Mailing Address - Phone:586-226-6252
Mailing Address - Fax:586-226-6255
Practice Address - Street 1:20225 E 9 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1775
Practice Address - Country:US
Practice Address - Phone:586-772-1090
Practice Address - Fax:586-772-4366
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315028539OtherCONT SUB LICENSE
MI4301081978OtherPHYS LICENSE