Healthcare Provider Details

I. General information

NPI: 1932351178
Provider Name (Legal Business Name): JERRY A RUBIN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/14/2018
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 TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME66320
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME66320
License Number StateFL

VIII. Authorized Official

Name: DR. JERRY ALAN RUBIN
Title or Position: PRESIDENT
Credential: MD
Phone: 321-939-3300