Provider Demographics
NPI:1619298403
Name:RUBLEY, TATE CHRISTOPHER (PA)
Entity Type:Individual
Prefix:
First Name:TATE
Middle Name:CHRISTOPHER
Last Name:RUBLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 PRESTON RD STE 901
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9593
Mailing Address - Country:US
Mailing Address - Phone:888-902-1704
Mailing Address - Fax:
Practice Address - Street 1:5899 PRESTON RD STE 901
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9593
Practice Address - Country:US
Practice Address - Phone:469-353-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX827N92OtherBCBS
TXP01231409OtherRAILROAD MEDICARE
TX218142201Medicaid
TXTXB110893Medicare PIN