Basic Information
| Provider Information | |||||||||
| NPI: | 1346256260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBLE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LESLIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850489 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366850489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423949 | ||||||||
| FaxNumber: | 2516313361 | ||||||||
| Practice Location | |||||||||
| Address1: | 9971 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366089525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516603500 | ||||||||
| FaxNumber: | 2516603501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | 24460 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | 00024460 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 511-09238 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 125019 | 05 | AL | MEDICAID |