Healthcare Provider Details

I. General information

NPI: 1083906945
Provider Name (Legal Business Name): ANTHONY CUBB MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 VETERANS MEMORIAL DR STE 109
HOUSTON TX
77067-1055
US

IV. Provider business mailing address

12033 VETERANS MEMORIAL DR STE 109
HOUSTON TX
77067-1055
US

V. Phone/Fax

Practice location:
  • Phone: 281-973-0885
  • Fax:
Mailing address:
  • Phone: 281-973-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberJ3775
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberJ3775
License Number StateTX

VIII. Authorized Official

Name: DR. ANTHONY CUBB
Title or Position: PRESIDENT
Credential: MD
Phone: 281-973-0885