Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | MD20381 | OR |
NPI | 1114081700 |
---|---|
Provider Name | George Kubac |
First Address | Klamath Falls, OR 97601-1132 |
Second Address | Klamath Falls, OR 97601-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 12/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060051986 | RAILROAD MEDICARE (01) | |
060060517 | RAILROAD MEDICARE (01) | |
164981 | (05) | OR |
F52145 | (02) | OR |