Provider Demographics
NPI:1861430506
Name:RUBANO, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:RUBANO
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 1:13115 NE 4TH ST
Mailing Address - Street 2:STE 230
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5965
Mailing Address - Country:US
Mailing Address - Phone:360-448-2047
Mailing Address - Fax:360-450-2289
Practice Address - Street 1:13115 NE 4TH ST
Practice Address - Street 2:STE 230
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-448-2047
Practice Address - Fax:360-450-2289
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154418208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427122Medicaid
I33892Medicare UPIN
WA8427122Medicaid