Healthcare Provider Details

I. General information

NPI: 1376002675
Provider Name (Legal Business Name): JEFFREY BUBLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 WEST LOOP SOUTH SUITE #500
BELLAIRE TX
77401
US

IV. Provider business mailing address

9240 N SAM HOUSTON PKWY E STE 201
HUMBLE TX
77396-5141
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberU3801
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberU3801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: