Healthcare Provider Details

I. General information

NPI: 1154705200
Provider Name (Legal Business Name): DUSTIN J TUBRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 04/29/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN STE 201
HOT SPRINGS AR
71913-6457
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2229
  • Fax: 501-623-0921
Mailing address:
  • Phone: 318-235-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTEP7573
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD17112
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-15257
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: