MEDICARE: DR. DAVID M RUBIN PH.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	103TC0700X	Clinical Psychologist	1115	AZ

General Provider Information

NPI Number	:	1548390610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M RUBIN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 13776
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85732-3776
Country	:	US
Telephone Number	:	520-529-8190
Fax Number	:	520-529-2557

Provider Business Practice Location Address
First Line	:	5680 N CAMINO REAL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4212
Country	:	US
Telephone Number	:	520-296-4280
Fax Number	:	520-296-3835

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/23/2012

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