Healthcare Provider Details

I. General information

NPI: 1447206347
Provider Name (Legal Business Name): JENNIFER LYNN KUBA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SPRINGHILL AVE MOBILE OUTPATIENT CLINIC
MOBILE AL
36604
US

IV. Provider business mailing address

12619 WAXWING AVE
SPANISH FORT AL
36527-5258
US

V. Phone/Fax

Practice location:
  • Phone: 251-219-3900
  • Fax:
Mailing address:
  • Phone: 216-410-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36.003417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: