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General NPI Number Information
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NPI Number | 1043562267
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Entity Type | Individual
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Provider Name | MR. CRAIG DOUGLAS ROUBEN
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Gender | Male
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 110 CHASE WAY STE 2
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7827
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Country | US
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Telephone | 502-212-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MARKET ST
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City | CHARLESTOWN
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State | IN
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Zip | 47111-9535
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Country | US
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Telephone | 812-246-9809
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Fax | 770-573-9513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007663
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License Number State | KY
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