Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2006001523 | MO |
NPI | 1053329169 |
---|---|
Provider Name | Dr. Victoria D. Kubik |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 03/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
# PENDING | (05) | MO |
I31908 | (02) | MO |