Provider Demographics
NPI:1659635159
Name:CHANG, RUBENS (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBENS
Middle Name:
Last Name:CHANG
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 1:525 BOB PETERS GRV STE 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4533
Mailing Address - Country:US
Mailing Address - Phone:719-365-6568
Mailing Address - Fax:719-365-6317
Practice Address - Street 1:525 BOB PETERS GRV STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4533
Practice Address - Country:US
Practice Address - Phone:719-365-6568
Practice Address - Fax:719-365-6317
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058204207RX0202X, 207R00000X, 207RH0003X, 207RX0202X
NH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000146272Medicaid