Basic Information
Provider Information
NPI: 1467402867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUBLE
FirstName: CRAIG
MiddleName: RICHARD
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12639 OLD TESSON RD
Address2: SUITE 115
City: SAINT LOUIS
State: MO
PostalCode: 631282786
CountryCode: US
TelephoneNumber: 3148490311
FaxNumber: 3148494423
Practice Location
Address1: 1390 HIGHWAY 61
Address2: JHM MOC SUITE G1000
City: FESTUS
State: MO
PostalCode: 630284137
CountryCode: US
TelephoneNumber: 6369337400
FaxNumber: 6369337403
Other Information
ProviderEnumerationDate: 05/10/2006
LastUpdateDate: 07/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X2002008842MOY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
090151501MOUNITED HEALTHCAREOTHER
18534201MOBLUE CROSS BLUE SHIELDOTHER
707534701MOAETNAOTHER
48218601MOHEALTHLINKOTHER
18905801MOGROUP HEALTH PLANOTHER
20602371505MO MEDICAID
P0006523701MORAILROAD MEDICAREOTHER


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