Provider Demographics
NPI:1023031044
Name:RUBIO, MYRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:L
Last Name:RUBIO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 5A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-747-5900
Mailing Address - Fax:314-747-5936
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 5A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-5900
Practice Address - Fax:314-747-5936
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
MO2000145650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205365208Medicaid
ILENROLLEDMedicaid
MO110230500Medicare PIN
MO356010183Medicaid