MEDICARE: DR. RUBY LYNN ZUBROD CCC A

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	231H00000X	Audiologist	200342	CO
2	231H00000X	Audiologist	A-994	WY

General Provider Information

NPI Number	:	1609957059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBY LYNN ZUBROD CCC A

Provider Business Mailing Address
First Line	:	PO BOX 21804
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003
Country	:	US
Telephone Number	:	307-426-4327
Fax Number	:	307-426-4327

Provider Business Practice Location Address
First Line	:	7215 COMMONS CIR
Second Line	:	UNIT C
City	:	CHEYENNE
State	:	WY
Zip	:	82009-2666
Country	:	US
Telephone Number	:	307-426-4327
Fax Number	:	307-638-0394

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/26/2018

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