Provider Demographics
NPI:1144605908
Name:RUBINFELD, COREY (PAC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:RUBINFELD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 11TH AVENUE NE, SUITE 200
Mailing Address - Street 2:MEDEX NORTHWEST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:303-550-1289
Mailing Address - Fax:
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:095-485-8155
Practice Address - Fax:509-548-2510
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA1435363A00000X
WAPA60923665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2124456Medicaid
WA140305OtherDEPARTMENT OF LABOR & INDUSTRIES
WA414518OtherDEPARTMENT OF LABOR & INDUSTRIES