Provider Demographics
NPI:1942704317
Name:ETIENNE, DAVID RUBBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUBBEN
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 W RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1694
Mailing Address - Country:US
Mailing Address - Phone:856-853-2056
Mailing Address - Fax:856-686-5218
Practice Address - Street 1:220 BARTON BLVD UNIT C14
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2742
Practice Address - Country:US
Practice Address - Phone:321-639-5177
Practice Address - Fax:321-639-4927
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME145925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program