Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 23722 | TX |
N | 103T00000X | Psychologist | 23722 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 23722 | TX |
Y | 103G00000X | Clinical Psychologist | 23722 | TX |
Y | 103TC0700X | Clinical Psychologist | 23722 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 23722 | TX |
N | 103TH0100X | Health Service | 23722 | TX |
N | 103TP2701X | Group Psychotherapist | 23722 | TX |
NPI | 1245304245 |
---|---|
Provider Name | Dr. John Gerard Rubel |
First Address | Pflugerville, TX 78691-2738 |
Second Address | Pflugerville, TX 78660-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 28/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0093ES | BCBS PROVIDER IDENTIFICAT (01) | TX |