Provider Demographics
NPI:1679522551
Name:RUBRIGHT, JON S (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:S
Last Name:RUBRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3000
Mailing Address - Fax:
Practice Address - Street 1:80 HEALTH PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4644
Practice Address - Country:US
Practice Address - Phone:303-666-2710
Practice Address - Fax:303-673-0438
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0029780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE40580Medicare UPIN
CO01297803Medicaid
COA495-8Medicare ID - Type Unspecified