Provider Demographics
NPI:1326018615
Name:RUBIN, GLENN LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:LAWRENCE
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 1:1905 CLINT MOORE RD
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:561-994-5454
Mailing Address - Fax:
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 2001
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-994-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00413515OtherRAILROAD MEDICARE
FL35979OtherBCBS OF FL
FL35979YMedicare PIN
FL35979OtherBCBS OF FL