Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 16775 | NV |
N | 207X00000X | Orthopaedic Surgeon | 6597691-1205 | UT |
NPI | 1003825753 |
---|---|
Provider Name | Erik Noble Kubiak |
First Address | Las Vegas, NV 89133-5380 |
Second Address | Las Vegas, NV 89102-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 03/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8460222 | (05) | WA |
I60438 | (02) | WA |