Provider Demographics
NPI:1205819661
Name:RUBNER, PAMELA MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:RUBNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:DESELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 S. MCCASLIN BLVD.
Mailing Address - Street 2:#103
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-666-7337
Mailing Address - Fax:303-666-7379
Practice Address - Street 1:400 S. MCCASLIN BLVD
Practice Address - Street 2:#103
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-666-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT54123901205208000000X
WI45172208000000X
ORMD150351208000000X
CODR.0055858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics