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General NPI Number Information
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NPI Number | 1376794339
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Entity Type | Organization
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Legal Business Name | DEAN A. RUBLE DO, PLC
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 435 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4672
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Country | US
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Telephone | 616-233-9986
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Fax | 616-233-9987
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Provider Business Mailing Address
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Address Line | 435 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4672
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Country | US
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Telephone | 616-233-9986
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Fax | 616-233-9987
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Authorized Official
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Title or Position | OWNER
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Name | DEAN A RUBLE
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Credential | DO
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Telephone | 616-233-9986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101013173
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License Number State | MI
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