Provider Demographics
NPI:1497742084
Name:RUBEN, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:RUBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2290 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2929
Mailing Address - Country:US
Mailing Address - Phone:707-643-5785
Mailing Address - Fax:707-643-8810
Practice Address - Street 1:480 CHADBOURNE RD 201
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9647
Practice Address - Country:US
Practice Address - Phone:707-399-4500
Practice Address - Fax:707-643-8810
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75891174400000X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology