Provider Demographics
NPI:1639148711
Name:RUBIO, JUAN ELIAS JR (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ELIAS
Last Name:RUBIO
Suffix:JR
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78292-0356
Mailing Address - Country:US
Mailing Address - Phone:210-615-7800
Mailing Address - Fax:210-615-8505
Practice Address - Street 1:9910 HUEBNER RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1375
Practice Address - Country:US
Practice Address - Phone:210-615-7600
Practice Address - Fax:210-615-8505
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.023206207W00000X
TXL4683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152048803Medicaid
TX8154B7Medicare PIN
G59490Medicare UPIN
LA5Y694Medicare ID - Type Unspecified