Provider Demographics
NPI:1821186453
Name:RUBIN, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:RUBIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-428-5600
Mailing Address - Fax:325-428-5609
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1010
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-428-5500
Practice Address - Fax:325-428-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-07-23
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Provider Licenses
StateLicense IDTaxonomies
LA15728208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1962805Medicaid
LAE07149Medicare UPIN
LA5R594Medicare PIN