Healthcare Provider Details

I. General information

NPI: 1316915622
Provider Name (Legal Business Name): JOHN R LUBBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24930 OUTLOOK DR
CARMEL CA
93923-8939
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 831-250-1787
  • Fax: 888-283-7270
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG66896
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG66896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: