Provider Demographics
NPI:1821091422
Name:RUBIN, BRENT LANE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LANE
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 BOWFIN TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5822
Mailing Address - Country:US
Mailing Address - Phone:941-448-9178
Mailing Address - Fax:941-580-6670
Practice Address - Street 1:14911 BOWFIN TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5822
Practice Address - Country:US
Practice Address - Phone:941-448-9178
Practice Address - Fax:941-580-6670
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3236213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340652100Medicaid
1069350001Medicare NSC
FLAB498XMedicare PIN
FLT80486Medicare UPIN