Healthcare Provider Details

I. General information

NPI: 1063434918
Provider Name (Legal Business Name): JAY J RUBIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SW 32ND PL STE 100
OCALA FL
34474-7163
US

IV. Provider business mailing address

2685 SW 32ND PL STE 100
OCALA FL
34474-7163
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-9643
  • Fax: 352-732-5952
Mailing address:
  • Phone: 352-732-9643
  • Fax: 352-732-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME42777
License Number StateFL

VIII. Authorized Official

Name: NICOLE LOCKHART
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 352-732-9643