Healthcare Provider Details

I. General information

NPI: 1912985102
Provider Name (Legal Business Name): RICHARD RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1802
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1802
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7295
  • Fax:
Mailing address:
  • Phone: 707-423-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberC1-004091
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC1-004091
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberC1-004091
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberC1-004091
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: