Provider Demographics
NPI:1609059567
Name:RUBIN, MICHAEL JONAH (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONAH
Last Name:RUBIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S ROCK ST
Mailing Address - Street 2:WESTLAKE ANESTHESIA GROUP, PA
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5837
Mailing Address - Country:US
Mailing Address - Phone:512-279-0348
Mailing Address - Fax:512-371-8788
Practice Address - Street 1:1004 S ROCK ST
Practice Address - Street 2:WESTLAKE ANESTHESIA GROUP, PA
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5837
Practice Address - Country:US
Practice Address - Phone:512-279-0348
Practice Address - Fax:512-371-8788
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22618163W00000X
CA638205163W00000X
SCAPRN 4265367500000X
CA078638367500000X
TXAP122874367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326099402Medicaid
TX8489UJOtherBCBS
SCAN2080Medicaid
TXP01446743OtherRR
NC8053281Medicaid
TX326099402Medicaid
NC8053281Medicaid
TX311609YK6UMedicare PIN