Provider Demographics
NPI:1235182098
Name:RUBIN, GARY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0001
Mailing Address - Country:US
Mailing Address - Phone:931-762-4400
Mailing Address - Fax:931-762-4499
Practice Address - Street 1:1323 S. LOCUST AVENUE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-4400
Practice Address - Fax:931-762-4499
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17750207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3027659Medicaid
TN103I203185Medicare PIN