Healthcare Provider Details

I. General information

NPI: 1316942006
Provider Name (Legal Business Name): DAVID P ROUBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 BIGGIN HILL LN
LOUISVILLE KY
40220
US

IV. Provider business mailing address

4331 CHURCHMAN AVE STE 101
LOUISVILLE KY
40215-1164
US

V. Phone/Fax

Practice location:
  • Phone: 502-364-0902
  • Fax: 502-364-0099
Mailing address:
  • Phone: 502-364-0902
  • Fax: 502-364-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number19550
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: