Provider Demographics
NPI:1366482770
Name:RUBIN, SETH MITCHELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:MITCHELL
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 RAINTREE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-727-9995
Mailing Address - Fax:972-727-8350
Practice Address - Street 1:1125 RAINTREE CIR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5288
Practice Address - Country:US
Practice Address - Phone:972-727-9995
Practice Address - Fax:972-727-8350
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01524363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB121238OtherMEDICARE PART B EFFECT 02/01/2011
TX835N14OtherBC/BS TX - EFFECT. 02/01/2011
TX8N4557OtherBLUE CROSS BLUE SHIELD
TXP00954362OtherRAILRAOD MEDICARE
TXP00954362OtherRAILRAOD MEDICARE
Q00821Medicare UPIN
8B2574Medicare ID - Type Unspecified
TX6484850001Medicare NSC