Provider Demographics
NPI:1285727594
Name:RUBIN, LEWIS P (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:P
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ALBERTA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2709
Mailing Address - Country:US
Mailing Address - Phone:915-545-6720
Mailing Address - Fax:915-545-5755
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-545-7555
Practice Address - Fax:915-545-6975
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1022832080N0001X
TX441302080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586698Medicaid
FL59037OtherBLUE CROSS BLUE SHIELD
FL000229300Medicaid
OHE56803Medicare UPIN
FLAM146ZMedicare PIN
OHRU7348551Medicare PIN