Healthcare Provider Details

I. General information

NPI: 1881198372
Provider Name (Legal Business Name): RUBEN MOREJON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/29/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY STE 2150
WESTERVILLE OH
43082-7808
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 328-061-4533
  • Fax:
Mailing address:
  • Phone: 419-520-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.140609
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.140609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: