Provider Demographics
NPI:1063419133
Name:RUBY, KENNETH ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ERIC
Last Name:RUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 MEDPARK SQUARE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3812
Mailing Address - Country:US
Mailing Address - Phone:606-677-8360
Mailing Address - Fax:606-677-8399
Practice Address - Street 1:30 MEDPARK SQUARE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3812
Practice Address - Country:US
Practice Address - Phone:606-677-8360
Practice Address - Fax:606-677-8399
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34707208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64347073Medicaid
KY0169Medicare PIN
KYG09200Medicare UPIN
KY64347073Medicaid
KYP400038790Medicare PIN
KY340016130Medicare PIN