Healthcare Provider Details

I. General information

NPI: 1427046291
Provider Name (Legal Business Name): LAUREL A KUBBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E INDIAN SCHOOL RD #130
PHOENIX AZ
85016-6872
US

IV. Provider business mailing address

3102 E INDIAN SCHOOL RD #130
PHOENIX AZ
85016-6872
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-0202
  • Fax: 602-424-2053
Mailing address:
  • Phone: 602-252-0202
  • Fax: 602-424-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number15298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: