Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 04125 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS14970 | FL |
N | 207R00000X | Internist | OS14970 | FL |
N | 111NI0900X | Internist | OS14970 | FL |
NPI | 1316367196 |
---|---|
Provider Name | Gregory Rubin |
First Address | Naples, FL 34102-5886 |
Second Address | Naples, FL 34102-5886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100187700 | (05) | FL |
JL158 | MEDICARE (01) | FL |
T5A5K | BCBS (01) | FL |