Provider Demographics
NPI:1083654826
Name:RUBINOWICZ, BRUCE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:RUBINOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 MYSTIC POINTE DR
Mailing Address - Street 2:#1410
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4541
Mailing Address - Country:US
Mailing Address - Phone:615-300-8151
Mailing Address - Fax:786-463-1670
Practice Address - Street 1:3530 MYSTIC POINTE DR
Practice Address - Street 2:#1410
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4541
Practice Address - Country:US
Practice Address - Phone:615-300-8151
Practice Address - Fax:786-463-1670
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO11452084N0400X, 2084S0012X
FL123492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3039399OtherBCBS TN
TN130025292OtherRRMEDICARE
TN3802609Medicaid
TN3039399OtherBCBS TN
TN130025292OtherRRMEDICARE