Provider Demographics
NPI:1013970797
Name:RUBENOW, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:RUBENOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5374
Mailing Address - Country:US
Mailing Address - Phone:479-750-2742
Mailing Address - Fax:479-750-2781
Practice Address - Street 1:601 W MAPLE AVE STE 403
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5374
Practice Address - Country:US
Practice Address - Phone:479-750-2742
Practice Address - Fax:479-750-2781
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA299402084P0800X
ARE-66432084P0804X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDDLLMedicare PIN
GAD42326Medicare UPIN
AR5AE97Medicare PIN