Provider Demographics
NPI:1447240080
Name:RUBIO, RONALD ANGELO RUBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD ANGELO
Middle Name:RUBIN
Last Name:RUBIO
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:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1905
Mailing Address - Country:US
Mailing Address - Phone:870-365-2550
Mailing Address - Fax:870-743-2008
Practice Address - Street 1:123 CLAUDE PARRISH AVE.
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2994
Practice Address - Country:US
Practice Address - Phone:870-365-2550
Practice Address - Fax:870-743-2008
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1996207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149188001Medicaid
AR5M120Medicare ID - Type Unspecified
ARH58424Medicare UPIN