Healthcare Provider Details

I. General information

NPI: 1134237084
Provider Name (Legal Business Name): ADRIAN REUBEN MBBS, FRCP, FACG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE CSB 210, POB 250327
CHARLESTON SC
29425-8908
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-6901
  • Fax: 843-792-5187
Mailing address:
  • Phone: 843-792-6200
  • Fax: 843-792-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberLL25214
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number25214
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: