Provider Demographics
NPI:1043674062
Name:RUBIN, KEITH HARRISON (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:HARRISON
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 1:2100 N OCEAN BLVD
Mailing Address - Street 2:APT 501
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1934
Mailing Address - Country:US
Mailing Address - Phone:917-913-8511
Mailing Address - Fax:
Practice Address - Street 1:2100 N OCEAN BLVD
Practice Address - Street 2:APT 501
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-1934
Practice Address - Country:US
Practice Address - Phone:917-913-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine