Basic Information
| Provider Information | |||||||||
| NPI: | 1780778019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 LAFAYETTE DR STE 401 | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883436337 | ||||||||
| FaxNumber: | 6584810921 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 OLD HICKORY BLVD STE 1-260 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153767500 | ||||||||
| FaxNumber: | 6153767575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 115274 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 209811207 | 05 | MO | MEDICAID | ENROLLED | 05 | IL | MEDICAID |