Provider Demographics
NPI:1558628743
Name:SARSOUR, RUBA M (DO)
Entity Type:Individual
Prefix:
First Name:RUBA
Middle Name:M
Last Name:SARSOUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3911 AVENUE B STE 1100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-2100
Mailing Address - Fax:308-630-2138
Practice Address - Street 1:3911 AVENUE B STE 1100
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-630-2100
Practice Address - Fax:308-630-2138
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01687207RN0300X
NE2070207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19RGUOtherBCBS OF NC
NCNCZ1820322OtherMEDICARE
NC1558628743Medicaid