Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 36739 | MN |
NPI | 1033114335 |
---|---|
Provider Name | Carl B Tubbs |
First Address | Parker, CO 80134-5640 |
Second Address | Parker, CO 80134-5640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180015058 | RAILROAD MEDICARE (01) | MN |
180046282 | RAILROAD MEDICARE (01) | WI |
531263900 | (05) | MN |
F23114 | (02) |