Basic Information
| Provider Information | |||||||||
| NPI: | 1073768164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBACH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | PALMER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF UTAH DEPT OF INTERNAL MEDICINE | ||||||||
| Address2: | SCHOOL OF MEDICINE 4C10, 30 N 1900 E | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015855559 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF UTAH DEPT OF INTERNAL MEDICINE | ||||||||
| Address2: | SCHOOL OF MEDICINE 4C10, 30 N 1900 E | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015855559 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.