Provider Demographics
NPI:1588674014
Name:RUBIN, BRUCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:RUBIN
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 1:2801 NW 87TH AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1603
Mailing Address - Country:US
Mailing Address - Phone:305-653-5155
Mailing Address - Fax:
Practice Address - Street 1:2801 NW 87TH AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1603
Practice Address - Country:US
Practice Address - Phone:305-653-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME696262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31382WMedicare PIN
G28100Medicare UPIN