Healthcare Provider Details

I. General information

NPI: 1033192570
Provider Name (Legal Business Name): MARK S. RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 BONITA BEACH RD SE #201A
BONITA SPRINGS FL
34135-4773
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-947-3092
  • Fax: 239-947-1077
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-947-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME66879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: