Provider Demographics
NPI:1396969176
Name:RUBY, EARL C (DO)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:C
Last Name:RUBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4440 E HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5576
Mailing Address - Country:US
Mailing Address - Phone:972-723-5590
Mailing Address - Fax:972-723-5592
Practice Address - Street 1:4440 E HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5576
Practice Address - Country:US
Practice Address - Phone:972-723-5590
Practice Address - Fax:972-723-5592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030724104Medicaid
TX343164YL7AOtherMEDICARE - OTHER
TXH29411Medicare UPIN