Provider Demographics
NPI:1326015843
Name:RUBIS, BRENT ALBERT (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALBERT
Last Name:RUBIS
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 1:10119 E 80TH ST
Mailing Address - Street 2:STE. A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3407
Mailing Address - Country:US
Mailing Address - Phone:918-254-6793
Mailing Address - Fax:918-254-6796
Practice Address - Street 1:10119 E 80TH ST
Practice Address - Street 2:STE. A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3407
Practice Address - Country:US
Practice Address - Phone:918-254-6793
Practice Address - Fax:918-254-6796
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215102082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2542190OtherAETNA
OK7017123OtherAETNA
OK100181350AMedicaid
OK1323612001OtherCIGNA
OK1980515OtherUNITED HEALTHCARE
OKH19250Medicare UPIN