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General NPI Number Information
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NPI Number | 1609866953
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Entity Type | Individual
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Provider Name | GREGORY J RUBINO MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1717 OAK PARK BLVD FL 3
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8990
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Country | US
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Telephone | 337-494-4720
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Fax | 337-494-2085
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Provider Business Mailing Address
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Address Line | PO BOX 122425 DEPT 2425
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City | DALLAS
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State | TX
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Zip | 75312-0001
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Country | US
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Telephone | 337-494-2921
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Fax | 337-494-6523
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD199953
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License Number State | LA
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