Provider Demographics
NPI:1184727422
Name:RUBI, RODNEY T (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:T
Last Name:RUBI
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0249
Mailing Address - Country:US
Mailing Address - Phone:573-785-3984
Mailing Address - Fax:
Practice Address - Street 1:205 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-0157
Practice Address - Country:US
Practice Address - Phone:573-663-2525
Practice Address - Fax:573-663-7821
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO04-01123OtherUNITED HEALTH CARE
MO04-01124OtherUNITED HEALTHCARE
MO04-03473OtherUNITED HEALTH CARE
MO418570OtherHEALTHLINK
MO204018402Medicaid
MO04-01126OtherUNITED HEALTH CARE
1184727422OtherRAILROAD MEDICARE
MO127515OtherBLUE CROSS/BLUE SHIELD
MO018010497Medicare ID - Type Unspecified
1184727422OtherRAILROAD MEDICARE