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Individual

MR. CRAIG DOUGLAS ROUBEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
110 CHASE WAY STE 2, ELIZABETHTOWN, KY 42701-7827
(502) 212-0071
Mailing address
2100 MARKET ST, CHARLESTOWN, IN 47111-9535
(812) 246-9809
(770) 573-9513

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3007663
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1087566
STATE LICENSE
KY
05
201212500
IN
01
71004539A
STATE LICENSE
IN
01
IN3604006
MEDICARE IN
IN
Enumeration date
10/11/2012
Last updated
02/22/2024
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