Healthcare Provider Details

I. General information

NPI: 1447240080
Provider Name (Legal Business Name): RONALD ANGELO RUBIN RUBIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CLAUDE PARRISH AVE.
HARRISON AR
72601-2994
US

IV. Provider business mailing address

PO BOX 1905
HARRISON AR
72602-1905
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-2550
  • Fax: 870-743-2008
Mailing address:
  • Phone: 870-365-2550
  • Fax: 870-743-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE1996
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: