Healthcare Provider Details

I. General information

NPI: 1003009846
Provider Name (Legal Business Name): JEFFERY M REUBEN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OKATIE CTR BLVD STE 205
OKATIE SC
29909-7511
US

IV. Provider business mailing address

PO BOX 670
PORT ROYAL SC
29935-0670
US

V. Phone/Fax

Practice location:
  • Phone: 843-379-7746
  • Fax:
Mailing address:
  • Phone: 843-379-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFERY M REUBEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-379-7746