MEDICARE: DR. JERRY RUBIN MD

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	208000000X	Pediatrics Physician	DR.0022028	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10363285	OTHER		CAQH

General Provider Information

NPI Number	:	1235243411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY RUBIN MD

Provider Business Mailing Address
First Line	:	PO BOX 17982
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915
Country	:	US
Telephone Number	:	303-388-4256
Fax Number	:	303-388-7802

Provider Business Practice Location Address
First Line	:	3801 E FLORIDA AVE STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-2571
Country	:	US
Telephone Number	:	303-388-4256
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/10/2023

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