Provider Demographics
NPI:1639154727
Name:RUBIN, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:RUBIN
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 1:3401 PGA BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2825
Mailing Address - Country:US
Mailing Address - Phone:561-729-7771
Mailing Address - Fax:561-491-5507
Practice Address - Street 1:3401 PGA BLVD STE 430
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2825
Practice Address - Country:US
Practice Address - Phone:561-729-7771
Practice Address - Fax:561-491-5507
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71471207W00000X
FLME 103339207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3070948Medicaid
MAJ09143Medicare PIN
MAE56588Medicare UPIN