Healthcare Provider Details

I. General information

NPI: 1477558096
Provider Name (Legal Business Name): RICHARD MICHAEL RUBENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N UNIVERSITY DR STE 307
TAMARAC FL
33321-6102
US

IV. Provider business mailing address

7421 N UNIVERSITY DR STE 307
TAMARAC FL
33321-6102
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-7272
  • Fax: 954-720-1878
Mailing address:
  • Phone: 954-720-7272
  • Fax: 954-720-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME53550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: