Provider Demographics
NPI:1386619765
Name:HARRIS, RUBIN (MD)
Entity type:Individual
Prefix:
First Name:RUBIN
Middle Name:
Last Name:HARRIS
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:PO BOX 142672
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-2672
Mailing Address - Country:US
Mailing Address - Phone:512-342-0455
Mailing Address - Fax:512-342-0460
Practice Address - Street 1:1301 WONDER WORLD DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7533
Practice Address - Country:US
Practice Address - Phone:512-342-0455
Practice Address - Fax:512-342-0460
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
84824SOtherBCBS
TX133363505Medicaid
84824SOtherBCBS
86619FMedicare PIN