Provider Demographics
NPI:1821065111
Name:RUBINSON, SAMUEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:M
Last Name:RUBINSON
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 1:1601 E 19TH AVE STE 4500
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1289
Mailing Address - Country:US
Mailing Address - Phone:303-831-6100
Mailing Address - Fax:303-831-8200
Practice Address - Street 1:1601 E 19TH AVE STE 4500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1289
Practice Address - Country:US
Practice Address - Phone:303-831-6100
Practice Address - Fax:303-831-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-05
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01240662Medicaid
CO01240662Medicaid