Healthcare Provider Details

I. General information

NPI: 1134136997
Provider Name (Legal Business Name): JERRY ALAN RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TURKEY LAKE RD SUITE 1-7
ORLANDO FL
32819-4707
US

IV. Provider business mailing address

6900 TURKEY LAKE RD SUITE 1-7
ORLANDO FL
32819-4707
US

V. Phone/Fax

Practice location:
  • Phone: 321-939-3300
  • Fax: 321-939-3303
Mailing address:
  • Phone: 321-939-3300
  • Fax: 321-939-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME 66320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: