Provider Demographics
NPI:1679565535
Name:ROUBIAN, PAUL A (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:ROUBIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1410 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090
Mailing Address - Country:US
Mailing Address - Phone:573-576-8316
Mailing Address - Fax:636-432-1317
Practice Address - Street 1:307 BOATNER ROAD
Practice Address - Street 2:EGLIN AIRFORCE BASE
Practice Address - City:EGLIN AIRFORCE BASE
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-9279
Practice Address - Fax:850-883-8400
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20080106962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01436539Medicaid
NY01436539Medicaid
NY38066FMedicare PIN
NYA60349Medicare UPIN