Provider Demographics
NPI:1013071166
Name:RUBIS PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:RUBIS PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-254-6793
Mailing Address - Street 1:10119-A EAST 80TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-254-6793
Mailing Address - Fax:918-254-6796
Practice Address - Street 1:10119 E 80TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3407
Practice Address - Country:US
Practice Address - Phone:918-254-6793
Practice Address - Fax:918-254-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215102082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749040AMedicaid