Provider Demographics
NPI:1295858942
Name:RUBEN, FREDERICK LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LEON
Last Name:RUBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FREDERICK
Other - Middle Name:LEON
Other - Last Name:RUBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 DISCOVERY DR
Mailing Address - Street 2:BOX 187
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370-9100
Mailing Address - Country:US
Mailing Address - Phone:570-839-5633
Mailing Address - Fax:570-839-2038
Practice Address - Street 1:1 DISCOVERY DR
Practice Address - Street 2:BOX 187
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370-9100
Practice Address - Country:US
Practice Address - Phone:570-839-5633
Practice Address - Fax:570-839-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013921E207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD013921EOtherPA LICENSE