Provider Demographics
NPI:1679872493
Name:XI, RUBY XIAOCHUN (MD)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:XIAOCHUN
Last Name:XI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 GAUSE BLVD # 75
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2939
Mailing Address - Country:US
Mailing Address - Phone:985-280-3609
Mailing Address - Fax:985-280-9651
Practice Address - Street 1:901 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2937
Practice Address - Country:US
Practice Address - Phone:985-280-8970
Practice Address - Fax:985-280-8971
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.205988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program