Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN7411 | FL |
NPI | 1154338077 |
---|---|
Provider Name | Dr. Ronald L Rubin |
First Address | Boca Raton, FL 33486 |
Second Address | Boca Raton, FL 33486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 23/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T86014 | (02) | FL |