Provider Demographics
NPI:1467402867
Name:RUBLE, CRAIG RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RICHARD
Last Name:RUBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:1390 HIGHWAY 61
Practice Address - Street 2:JHM MOC SUITE G1000
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-933-7400
Practice Address - Fax:636-933-7403
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2002008842207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0901515OtherUNITED HEALTHCARE
MO185342OtherBLUE CROSS BLUE SHIELD
MO7075347OtherAETNA
MO482186OtherHEALTHLINK
MO189058OtherGROUP HEALTH PLAN
MO206023715Medicaid
MOP00065237OtherRAILROAD MEDICARE