Provider Demographics
NPI:1164463162
Name:RUBIO, GUILLERMO R (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:R
Last Name:RUBIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABEL
Other - Middle Name:GUILLERMO
Other - Last Name:RUBIO-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4414 S MADELIA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6430
Mailing Address - Country:US
Mailing Address - Phone:509-448-0370
Mailing Address - Fax:
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7000
Practice Address - Fax:509-434-7130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00014614207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD-000Medicare UPIN