Provider Demographics
NPI:1548390610
Name:RUBIN, DAVID M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PHD
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 13776
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-3776
Mailing Address - Country:US
Mailing Address - Phone:520-529-8190
Mailing Address - Fax:520-529-2557
Practice Address - Street 1:5680 N CAMINO REAL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4212
Practice Address - Country:US
Practice Address - Phone:520-296-4280
Practice Address - Fax:520-296-3835
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y05485Medicare UPIN
78256Medicare ID - Type Unspecified