Healthcare Provider Details

I. General information

NPI: 1932155561
Provider Name (Legal Business Name): JASON PHILIP RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9575 ETHAN WADE WAY SE
SNOQUALMIE WA
98065-9577
US

IV. Provider business mailing address

9801 FRONTIER AVE SE
SNOQUALMIE WA
98065-5200
US

V. Phone/Fax

Practice location:
  • Phone: 425-831-2321
  • Fax: 425-831-2361
Mailing address:
  • Phone: 425-831-2321
  • Fax: 425-831-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00037081
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00037081
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00037081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: