Provider Demographics
NPI:1972696045
Name:RUBLE, REBECCA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:RUBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 MISSION RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4216
Mailing Address - Country:US
Mailing Address - Phone:913-632-9880
Mailing Address - Fax:913-632-9881
Practice Address - Street 1:7501 MISSION RD STE 103
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4216
Practice Address - Country:US
Practice Address - Phone:913-632-9880
Practice Address - Fax:913-632-9881
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11456071OtherBLUE CROSS
KS626950OtherFIRSTGUARD
KS11456071OtherBLUE CROSS
E23395Medicare UPIN
KSS145371Medicare ID - Type Unspecified