Provider Demographics
NPI:1699921940
Name:RUBIN, MARSHALL WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:WILLIAM
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 N BAYLEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1703
Mailing Address - Country:US
Mailing Address - Phone:850-595-1949
Mailing Address - Fax:
Practice Address - Street 1:2257 N BAYLEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1703
Practice Address - Country:US
Practice Address - Phone:850-595-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant