Provider Demographics
NPI:1104894880
Name:BARAKAT, RUBA F (MD)
Entity type:Individual
Prefix:DR
First Name:RUBA
Middle Name:F
Last Name:BARAKAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3223
Mailing Address - Country:US
Mailing Address - Phone:601-483-5322
Mailing Address - Fax:601-581-2289
Practice Address - Street 1:1600 22ND AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3223
Practice Address - Country:US
Practice Address - Phone:601-483-5322
Practice Address - Fax:601-581-2289
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01088406A207R00000X
MI4301119101207R00000X
MS19227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04685716Medicaid
AL009936153Medicaid
731-04381OtherBLUE CROSS OF AL
I51716Medicare UPIN
731-04381OtherBLUE CROSS OF AL