Provider Demographics
NPI:1083646657
Name:RUBENS, BRANDON S (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:S
Last Name:RUBENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7153 TALTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9002
Mailing Address - Country:US
Mailing Address - Phone:269-290-3664
Mailing Address - Fax:919-854-7842
Practice Address - Street 1:218 ASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6118
Practice Address - Country:US
Practice Address - Phone:919-576-2330
Practice Address - Fax:919-854-7842
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075887208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3403912292OtherBCBS IND PIN
156574OtherGREAT LAKES HLTH PLAN
MI488522410Medicaid
340C910480OtherBCBS GRP PIN
3403912292OtherBCBS IND PIN
I54595Medicare UPIN
3403912292OtherBCBS IND PIN