Provider Demographics
NPI:1598709925
Name:RUBIN, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
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 1:8950 SW NIMBUS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7119
Mailing Address - Country:US
Mailing Address - Phone:503-697-3255
Mailing Address - Fax:503-697-7792
Practice Address - Street 1:8950 SW NIMBUS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7119
Practice Address - Country:US
Practice Address - Phone:503-697-3255
Practice Address - Fax:503-697-7792
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09620208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029280Medicaid
OR029280Medicaid
OR120481Medicare ID - Type Unspecified