Provider Demographics
NPI:1346579786
Name:FERN J RUBIN M.D.
Entity Type:Organization
Organization Name:FERN J RUBIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FERN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-546-4301
Mailing Address - Street 1:5851 DULUTH ST STE 317
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3957
Mailing Address - Country:US
Mailing Address - Phone:763-546-4301
Mailing Address - Fax:
Practice Address - Street 1:5851 DULUTH ST STE 317
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3957
Practice Address - Country:US
Practice Address - Phone:763-546-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty