Provider Demographics
NPI:1225397847
Name:RUBERG, TARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:RUBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 SW 18TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7015
Mailing Address - Country:US
Mailing Address - Phone:561-368-3775
Mailing Address - Fax:561-392-7139
Practice Address - Street 1:6859 SW 18TH ST
Practice Address - Street 2:STE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7015
Practice Address - Country:US
Practice Address - Phone:561-368-3775
Practice Address - Fax:561-392-7139
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143781207V00000X
PAMD458251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103133077Medicaid