Provider Demographics
NPI:1396859617
Name:RUBIN, ALEC M (MD)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:M
Last Name:RUBIN
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 1:3884 CENTRAL SARASOTA PKWY
Mailing Address - Street 2:SUITE 429
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3046
Mailing Address - Country:US
Mailing Address - Phone:941-244-9430
Mailing Address - Fax:941-244-9437
Practice Address - Street 1:3884 CENTRAL SARASOTA PKWY
Practice Address - Street 2:SUITE 429
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-3046
Practice Address - Country:US
Practice Address - Phone:941-244-9430
Practice Address - Fax:941-244-9437
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266051200Medicaid
FL62780OtherBCBS
FL62780XMedicare ID - Type Unspecified
FL62780OtherBCBS