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General NPI Number Information
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NPI Number | 1689044372
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Entity Type | Individual
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Provider Name | MR. JASON ROBERT RUBERG
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Gender | Male
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 8099 CORNELL RD
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City | CINCINNATI
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State | OH
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Zip | 45249-2231
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Country | US
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Telephone | 513-793-3933
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Fax | 513-793-8299
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Provider Business Mailing Address
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Address Line | 560 S LOOP RD
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City | EDGEWOOD
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State | KY
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Zip | 41017-3405
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Country | US
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Telephone | 859-301-2663
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Fax | 859-817-7848
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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