Provider Demographics
NPI:1467464594
Name:KASSANOFF, RUBY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:ELIZABETH
Last Name:KASSANOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 GASTON
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-823-4800
Mailing Address - Fax:214-823-4801
Practice Address - Street 1:3417 GASTON AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-823-4800
Practice Address - Fax:214-823-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84424XOtherBCBS
TX046195601Medicaid
TX046195601Medicaid
TXG89333Medicare UPIN
TX87X766Medicare PIN