Provider Demographics
NPI:1427003003
Name:ROUBEN, LAWRENCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:R
Last Name:ROUBEN
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 1:3805 SAN DIMAS ST STE B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5725
Mailing Address - Country:US
Mailing Address - Phone:803-592-0105
Mailing Address - Fax:
Practice Address - Street 1:28400 MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9658
Practice Address - Country:US
Practice Address - Phone:661-432-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73813207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000330391OtherBLUE SHIELD
KS000000330391OtherKY ACCESS
KY000000616427OtherANTHEM- NORTON INPATIENT SPECIALISTS
KY3728765000OtherPASSPORT ADVANTAGE- NORTON INPATIENT SPECIALISTS
KY000023036QOtherHUMANA- NORTON INPATIENT SPECIALISTS
KY200116640OtherMEDICAID INDIANA- NORTON INPATIENT SPECIALISTS
KY200116640OtherANTHEM INDIANA MEDICAID- NORTON INPATIENT SPECIALISTS
051953OtherSIHO
KY50001316Medicaid
KY64260706Medicaid
KY50025004OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KY00533134OtherMEDICARE- NORTON INPATIENT SPECIALISTS
IN200116640AMedicaid
KY2442925000Medicaid
KY000000330391OtherBLUE SHIELD
KY00533134OtherMEDICARE- NORTON INPATIENT SPECIALISTS
KS000000330391OtherKY ACCESS
IN200116640AMedicaid
COCO300894Medicare PIN