Healthcare Provider Details

I. General information

NPI: 1992790158
Provider Name (Legal Business Name): ALAN M. RUBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHAPLINE ST
WHEELING WV
26003-3875
US

IV. Provider business mailing address

PO BOX 894830 LOCK BOX 4830
LOS ANGELES CA
90189-4830
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-7151
  • Fax: 304-232-6128
Mailing address:
  • Phone: 304-232-7151
  • Fax: 304-232-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11124
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: