MEDICARE: RUBICONMD FLORIDA PHYSICIANS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207N00000X	Dermatology Physician
3	207RC0000X	Cardiovascular Disease Physician
4	207RH0003X	Hematology & Oncology Physician
5	207RI0200X	Infectious Disease Physician
6	207RN0300X	Nephrology Physician
7	207V00000X	Obstetrics & Gynecology Physician
8	208000000X	Pediatrics Physician
9	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1033701586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBICONMD FLORIDA PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	4953 MCGILL WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2720
Country	:	US
Telephone Number	:	781-879-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 S DALE MABRY HWY UNIT 4105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1434
Country	:	US
Telephone Number	:	860-262-4489
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ERIC ADDO
Credential	:	MD
Telephone Number	:	860-262-4489

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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Directions to “RUBICONMD FLORIDA PHYSICIANS, PLLC ” Practice Location

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