Healthcare Provider Details

I. General information

NPI: 1306815337
Provider Name (Legal Business Name): JOEL ADAM RUBENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14027 5TH ST
DADE CITY FL
33525-4302
US

IV. Provider business mailing address

PO BOX 232
DADE CITY FL
33526-0232
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax: 352-567-1974
Mailing address:
  • Phone: 352-518-2000
  • Fax: 352-567-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: