Provider Demographics
NPI:1750473047
Name:RUBASHKIN, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:RUBASHKIN
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 1:9337B KATY FWY
Mailing Address - Street 2:PMB 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1515
Mailing Address - Country:US
Mailing Address - Phone:713-463-9449
Mailing Address - Fax:
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-463-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG17632084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137540409Medicaid
TX137540415Medicaid
TX00G341Medicare PIN
TX137540415Medicaid
TX8D2969Medicare PIN