Healthcare Provider Details

I. General information

NPI: 1336149046
Provider Name (Legal Business Name): THOMAS RUBIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR SUITE 279
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9710
  • Fax: 239-343-9715
Mailing address:
  • Phone: 239-424-1400
  • Fax: 239-424-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number33639
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: