Healthcare Provider Details

I. General information

NPI: 1669573457
Provider Name (Legal Business Name): BRADLEY H RUBEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 N ESSEX AVE
HERNANDO FL
34442
US

IV. Provider business mailing address

2484 N ESSEX AVE
HERNANDO FL
34442
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-1358
  • Fax: 352-746-1972
Mailing address:
  • Phone: 352-746-1358
  • Fax: 352-746-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0003264
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS0003264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: