MEDICARE: MARIO F. RUBIN, MD, PA

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1679765036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO F. RUBIN, MD, PA

Provider Business Mailing Address
First Line	:	5917 LAKE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3129
Country	:	US
Telephone Number	:	713-665-2783
Fax Number	:	713-665-2269

Provider Business Practice Location Address
First Line	:	5917 LAKE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3129
Country	:	US
Telephone Number	:	713-665-2783
Fax Number	:	713-665-2269

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO FERNANDO RUBIN
Credential	:	MD
Telephone Number	:	713-825-0642

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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