Provider Demographics
NPI:1346395837
Name:RUBY, JONATHAN D (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:RUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 HOSPITAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1872
Mailing Address - Country:US
Mailing Address - Phone:606-451-2628
Mailing Address - Fax:606-451-2641
Practice Address - Street 1:350 HOSPITAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1872
Practice Address - Country:US
Practice Address - Phone:606-451-2628
Practice Address - Fax:606-451-2641
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100010520Medicaid
KY000000503520OtherANTHEM
KY1231898OtherCHA
C92472OtherCUMBERLAND HEALTHCARE
5764646OtherCCN
KYP00423857OtherRAILROAD MEDICARE
KY7100010520Medicaid
KYP00423857OtherRAILROAD MEDICARE
5764646OtherCCN