Healthcare Provider Details

I. General information

NPI: 1801821756
Provider Name (Legal Business Name): JOHN MICHAEL LUBER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 102
TACOMA WA
98405-5303
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 102
TACOMA WA
98405-5303
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-7777
  • Fax: 253-426-4142
Mailing address:
  • Phone: 253-272-7777
  • Fax: 253-426-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD00035996
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: