Provider Demographics
NPI:1376538496
Name:RUBIN, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JONATHAN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9015 E PIMA CENTER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4613
Mailing Address - Country:US
Mailing Address - Phone:480-291-6440
Mailing Address - Fax:480-291-6441
Practice Address - Street 1:9015 E PIMA CENTER PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4613
Practice Address - Country:US
Practice Address - Phone:480-291-6440
Practice Address - Fax:480-291-6441
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28310207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77463Medicare ID - Type Unspecified
AZG03781Medicare UPIN