Basic Information
| Provider Information | |||||||||
| NPI: | 1750473047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBASHKIN | ||||||||
| FirstName: | BORIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9337B KATY FWY | ||||||||
| Address2: | PMB 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134639449 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9525 KATY FWY | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134639449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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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 | 2084P0800X | G1763 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | G1763 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 137540409 | 05 | TX | MEDICAID | 137540415 | 05 | TX | MEDICAID |