Healthcare Provider Details

I. General information

NPI: 1447360698
Provider Name (Legal Business Name): LAURENCE Z. RUBENSTEIN M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 NE 13TH ST STE 150 OU SENIOR HEALTH CENTER
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

1122 NE 13TH ST # 1200 REYNOLDS DEPARTMENT OF GERIATRIC MEDICINE
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3050
  • Fax: 405-271-3887
Mailing address:
  • Phone: 405-271-8124
  • Fax: 405-271-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number27943
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG32738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: