=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003952466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANUP KUBAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 HERITAGE DR STE 105
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-452-9922
-----------------------------------------------------
Fax | 954-452-7574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15340 S JOG RD STE 210
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-2170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-452-9922
-----------------------------------------------------
Fax | 954-452-7574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | P21410
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME103910
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------