MEDICARE: DR. ELBA I RUBIANES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME0065725	FL
2	207NS0135X	Procedural Dermatology Physician	ME0065725	FL
3	207NS0135X	Procedural Dermatology Physician	R9851	TX
4	207N00000X	Dermatology Physician	R9851	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	926255	OTHER	FL	NAPLES PHO NUMBER
2	25372	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1114904802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELBA I RUBIANES MD

Provider Business Mailing Address
First Line	:	4471 LONG PRAIRIE RD STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1755
Country	:	US
Telephone Number	:	972-316-4555
Fax Number	:	972-316-4550

Provider Business Practice Location Address
First Line	:	6000 W SPRING CREEK PKWY STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3617
Country	:	US
Telephone Number	:	972-316-4555
Fax Number	:	214-285-0791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	04/01/2020

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Directions to “ DR. ELBA I RUBIANES MD” Practice Location

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