Provider Demographics
NPI:1043562267
Name:ROUBEN, CRAIG DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:ROUBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9535
Mailing Address - Country:US
Mailing Address - Phone:812-246-9809
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:110 CHASE WAY STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7827
Practice Address - Country:US
Practice Address - Phone:502-212-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1087566OtherSTATE LICENSE
IN71004539AOtherSTATE LICENSE
ININ3604006OtherMEDICARE IN
IN201212500Medicaid