Provider Demographics
NPI:1275571879
Name:RUBIN DE CELIS, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:RUBIN DE CELIS
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:2911 MEDICAL ARTS ST
Practice Address - Street 2:SUITE 13
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3376
Practice Address - Country:US
Practice Address - Phone:512-478-9990
Practice Address - Fax:512-469-0116
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4682207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155437006Medicaid
TX155437002Medicaid
TX178274001Medicaid
TX155437003Medicaid
TX8R1598OtherBLUE CROSS OF TEXAS
TX8R1598OtherBLUE CROSS OF TEXAS
TXP00314951Medicare PIN
TX155437004Medicaid
TX8D7191Medicare PIN
TX8G1945Medicare PIN
H71711Medicare UPIN
TX8D6597Medicare PIN