Provider Demographics
NPI:1043348154
Name:RUBIN, KEITH MARTIN (DO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARTIN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25097 OLYMPIA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3914
Mailing Address - Country:US
Mailing Address - Phone:941-347-8744
Mailing Address - Fax:941-347-8756
Practice Address - Street 1:25097 OLYMPIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3914
Practice Address - Country:US
Practice Address - Phone:941-347-8744
Practice Address - Fax:941-347-8756
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD305ZOtherMEDICARE
FL37893OtherFL BC
FLAD305Medicare PIN
FLAD305ZOtherMEDICARE