Provider Demographics
NPI:1023132024
Name:RUBIN, HERBERT B (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:B
Last Name:RUBIN
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 1:1460 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5829
Mailing Address - Country:US
Mailing Address - Phone:850-222-1108
Mailing Address - Fax:850-224-5522
Practice Address - Street 1:1460 MARION AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5829
Practice Address - Country:US
Practice Address - Phone:850-222-1108
Practice Address - Fax:850-224-5522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059150500Medicaid
FL37236OtherBLUE CROSSBLUE SHIELD
FL37236Medicare ID - Type UnspecifiedMEDICARE
FL37236OtherBLUE CROSSBLUE SHIELD