Healthcare Provider Details

I. General information

NPI: 1376538496
Provider Name (Legal Business Name): MARK JONATHAN RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 E PIMA CENTER PKWY SUITE 1
SCOTTSDALE AZ
85258-4613
US

IV. Provider business mailing address

9015 E PIMA CENTER PKWY SUITE 1
SCOTTSDALE AZ
85258-4613
US

V. Phone/Fax

Practice location:
  • Phone: 480-291-6440
  • Fax: 480-291-6441
Mailing address:
  • Phone: 480-291-6440
  • Fax: 480-291-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number28310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: