Provider Demographics
NPI:1134167562
Name:RUBICK, VERNON (DO)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:
Last Name:RUBICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2420 E PIKES PEAK AVE
Mailing Address - Street 2:STE 1044
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6005
Mailing Address - Country:US
Mailing Address - Phone:719-365-6692
Mailing Address - Fax:719-365-5004
Practice Address - Street 1:8540 SCARBOROUGH DR
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7502
Practice Address - Country:US
Practice Address - Phone:719-955-4200
Practice Address - Fax:719-955-4201
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37183207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92627Medicare UPIN
465488Medicare ID - Type Unspecified