MEDICARE: DANIEL R. ROUBEIN M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	E-14574	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164427498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL R. ROUBEIN M.D.

Provider Business Mailing Address
First Line	:	500 S UNIVERSITY AVE
Second Line	:	STE 101
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5314
Country	:	US
Telephone Number	:	713-590-3641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S
Second Line	:	SUITE 900
City	:	HOUSTON
State	:	TX
Zip	:	77027-3515
Country	:	US
Telephone Number	:	713-590-3641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/14/2022

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