Provider Demographics
NPI:1649456914
Name:MARTIN H RUBIN MD PLLC
Entity type:Organization
Organization Name:MARTIN H RUBIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-839-7627
Mailing Address - Street 1:7525 E BROADWAY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2002
Mailing Address - Country:US
Mailing Address - Phone:480-839-7627
Mailing Address - Fax:480-839-7643
Practice Address - Street 1:7525 E BROADWAY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2002
Practice Address - Country:US
Practice Address - Phone:480-839-7627
Practice Address - Fax:480-839-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ12996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0037030OtherBCBS AZ
AZAZ7216OtherHEALTHNET OF AZ
AZ860527535OtherTRICARE
AZ226432Medicaid
AZ110005756OtherMEDICARE RAILROAD
AZAZ7216OtherHEALTHNET OF AZ
AZ226432Medicaid