Healthcare Provider Details

I. General information

NPI: 1013071166
Provider Name (Legal Business Name): RUBIS PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10119 E 80TH ST SUITE A
TULSA OK
74133-3407
US

IV. Provider business mailing address

10119-A EAST 80TH STREET SOUTH
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-254-6793
  • Fax: 918-254-6796
Mailing address:
  • Phone: 918-254-6793
  • Fax: 918-254-6796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number21510
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number21510
License Number StateOK

VIII. Authorized Official

Name: BRENT A. RUBIS
Title or Position: OWNER
Credential: MD
Phone: 918-254-6793