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General NPI Number Information
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NPI Number | 1467402867
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Entity Type | Individual
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Provider Name | CRAIG RICHARD RUBLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 1390 HIGHWAY 61 JHM MOC SUITE G1000
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-933-7400
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Fax | 636-933-7403
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Provider Business Mailing Address
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Address Line | 12639 OLD TESSON RD SUITE 115
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2786
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Country | US
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Telephone | 314-849-0311
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Fax | 314-849-4423
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2002008842
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License Number State | MO
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