Provider Demographics
NPI:1740574243
Name:RUBIN, STACY PAIGE (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:PAIGE
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GLADES RD.
Mailing Address - Street 2:BC-71, RM 139
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-297-2753
Mailing Address - Fax:
Practice Address - Street 1:670 GLADES RD STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6464
Practice Address - Country:US
Practice Address - Phone:561-955-2570
Practice Address - Fax:561-955-2572
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME120745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program