Provider Demographics
NPI:1629167630
Name:RUBIN, GARY STUART (PA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STUART
Last Name:RUBIN
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 1:1286 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2484
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-633-3043
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-636-7780
Practice Address - Fax:321-633-3043
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003353363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical