Provider Demographics
NPI:1235360546
Name:PETER A.D. RUBIN, M.D., P.A.
Entity Type:Organization
Organization Name:PETER A.D. RUBIN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:AD
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-729-7771
Mailing Address - Street 1:3401 PGA BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2825
Mailing Address - Country:US
Mailing Address - Phone:561-729-7771
Mailing Address - Fax:561-491-5507
Practice Address - Street 1:3401 PGA BLVD STE 430
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2825
Practice Address - Country:US
Practice Address - Phone:561-729-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 103339207W00000X
MA71471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ09143OtherMEDICARE ID- TYPE UNSPECIFIED
MA3070948Medicaid
MA3070948Medicaid