MEDICARE: DR. ALVIN R. KUBAT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PSY6938	CA
2	103TB0200X	Cognitive & Behavioral Psychologist	1979	OR

General Provider Information

NPI Number	:	1528278744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN R. KUBAT PH.D.

Provider Business Mailing Address
First Line	:	1201 NE 7TH STREET
Second Line	:	SUITE C
City	:	GRANTS PASS
State	:	OR
Zip	:	97526
Country	:	US
Telephone Number	:	541-450-5676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NE 7TH ST
Second Line	:	SUITE C
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1451
Country	:	US
Telephone Number	:	541-450-5676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/19/2010

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