Provider Demographics
NPI:1134136997
Name:RUBIN, JERRY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALAN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 TURKEY LAKE RD
Mailing Address - Street 2:SUITE 1-7
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4707
Mailing Address - Country:US
Mailing Address - Phone:321-939-3300
Mailing Address - Fax:321-939-3303
Practice Address - Street 1:6900 TURKEY LAKE RD
Practice Address - Street 2:SUITE 1-7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4707
Practice Address - Country:US
Practice Address - Phone:321-939-3300
Practice Address - Fax:321-939-3303
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 663202082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25310YOtherMEDICARE PTAN