Provider Demographics
NPI:1366822348
Name:RUBY, ALEXANDER JUDSON MOORE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JUDSON MOORE
Last Name:RUBY
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 1:898 N PACIFIC COAST HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2747
Mailing Address - Country:US
Mailing Address - Phone:310-379-2134
Mailing Address - Fax:
Practice Address - Street 1:898 N PACIFIC COAST HWY STE 600
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2747
Practice Address - Country:US
Practice Address - Phone:310-379-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067303207P00000X
CAA159865207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine