Provider Demographics
NPI:1568542470
Name:THORBUS, RUBEN S (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:S
Last Name:THORBUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E D ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-9545
Mailing Address - Country:US
Mailing Address - Phone:559-925-1000
Mailing Address - Fax:559-925-1084
Practice Address - Street 1:812 E D ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9545
Practice Address - Country:US
Practice Address - Phone:559-925-1000
Practice Address - Fax:559-925-1084
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G134590Medicaid
CAD49006Medicare UPIN
CA00G134590Medicaid