Provider Demographics
NPI:1871707331
Name:MARK A RUBIN, MD, PA
Entity type:Organization
Organization Name:MARK A RUBIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-325-1087
Mailing Address - Street 1:1903 NORTH 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4415
Mailing Address - Country:US
Mailing Address - Phone:318-325-1087
Mailing Address - Fax:318-325-1089
Practice Address - Street 1:1903 NORTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4415
Practice Address - Country:US
Practice Address - Phone:318-325-1087
Practice Address - Fax:318-325-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15728207R00000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1962805Medicaid
LA1962805Medicaid
LA5R594Medicare PIN