=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578844973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAD PHYSICIANS MEDICAL CORPORATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2011
-----------------------------------------------------
Last Update Date | 11/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 N CALIFORNIA ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95204-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-467-6556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4542
-----------------------------------------------------
City | CAROL STREAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60197-4542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-319-3552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | J PAUL RUBIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 602-319-3552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------