Healthcare Provider Details

I. General information

NPI: 1609310176
Provider Name (Legal Business Name): RUBIN FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25097 OLYMPIA AVE 203
PUNTA GORDA FL
33950-3912
US

IV. Provider business mailing address

25097 OLYMPIA AVE 203
PUNTA GORDA FL
33950-3912
US

V. Phone/Fax

Practice location:
  • Phone: 941-347-8744
  • Fax: 941-347-8756
Mailing address:
  • Phone: 941-347-8744
  • Fax: 941-347-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS8591
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH MARTIN RUBIN
Title or Position: OWNER
Credential: DO
Phone: 941-347-8744