Healthcare Provider Details

I. General information

NPI: 1770799652
Provider Name (Legal Business Name): DIANE RUBIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W RIVERSIDE AVE SUITE 200, MEPS
SPOKANE WA
99201-1010
US

IV. Provider business mailing address

920 W RIVERSIDE AVE SUITE 200
SPOKANE WA
99201-1010
US

V. Phone/Fax

Practice location:
  • Phone: 509-353-3105
  • Fax:
Mailing address:
  • Phone: 509-353-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00029014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: