MEDICARE: DR. VERNON RUBICK D.O.

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	207Q00000X	Family Medicine Physician	37183	CO

General Provider Information

NPI Number	:	1134167562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERNON RUBICK D.O.

Provider Business Mailing Address
First Line	:	2420 E PIKES PEAK AVE
Second Line	:	STE 1044
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-6005
Country	:	US
Telephone Number	:	719-365-6692
Fax Number	:	719-365-5004

Provider Business Practice Location Address
First Line	:	8540 SCARBOROUGH DR
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7502
Country	:	US
Telephone Number	:	719-955-4200
Fax Number	:	719-955-4201

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/12/2014

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