Provider Demographics
NPI:1316942006
Name:ROUBEN, DAVID P (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:ROUBEN
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 1:4331 CHURCHMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1164
Mailing Address - Country:US
Mailing Address - Phone:502-364-0902
Mailing Address - Fax:502-364-0099
Practice Address - Street 1:8620 BIGGIN HILL LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220
Practice Address - Country:US
Practice Address - Phone:502-364-0902
Practice Address - Fax:502-364-0099
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19550207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64195506Medicaid
KY200014437OtherRAILROAD MEDICARE
KY64195506Medicaid
KY000000048793OtherANTHEM BC/BS NUMBER
KYK012147OtherTRICARE
KY0343740001OtherMEDICARE DME
KY2434430000OtherPASSPORT ADVANTAGE
KYK047320OtherMEDICARE- NORTON LEATHERMAN SPINE
KY0273202Medicare ID - Type UnspecifiedMEDICARE NUMBER
KY2434430000OtherPASSPORT ADVANTAGE