MEDICARE: GLENN LAWRENCE 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	207R00000X	Internal Medicine Physician	ME80850	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00413515	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	35979	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1326018615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN LAWRENCE RUBIN MD

Provider Business Mailing Address
First Line	:	1905 CLINT MOORE RD
Second Line	:	SUITE 2001
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2658
Country	:	US
Telephone Number	:	561-994-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 CLINT MOORE RD
Second Line	:	SUITE 2001
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2658
Country	:	US
Telephone Number	:	561-994-5454
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	05/14/2008

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