Healthcare Provider Details

I. General information

NPI: 1427052463
Provider Name (Legal Business Name): JOEL A. RUBENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816A NE THURSTON WAY
VANCOUVER WA
98662
US

IV. Provider business mailing address

4201 NE 66TH AVE. SUITE 104
VANCOUVER WA
98661
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-4914
  • Fax: 360-449-4961
Mailing address:
  • Phone: 360-254-4914
  • Fax: 360-449-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00039184
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD22471
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4179
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: