Provider Demographics
NPI:1619919453
Name:REUBEN, BLAIR I (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:I
Last Name:REUBEN
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 1:9250 N THIRD STREET
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2412
Mailing Address - Country:US
Mailing Address - Phone:602-633-3800
Mailing Address - Fax:602-861-3500
Practice Address - Street 1:9250 N. THIRD STREET
Practice Address - Street 2:SUITE 4000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2412
Practice Address - Country:US
Practice Address - Phone:602-633-3800
Practice Address - Fax:602-861-3500
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ498106Medicaid
AZ61568Medicare PIN
AZE97878Medicare UPIN