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General NPI Number Information
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NPI Number | 1407059405
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Entity Type | Individual
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Provider Name | ANDREW LEE KUBIN PA-C, LAT
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 2460 N INTERSTATE 35E STE 215
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City | WAXAHACHIE
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State | TX
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Zip | 75165
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Country | US
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Telephone | 972-817-9570
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Fax | 972-817-9580
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Provider Business Mailing Address
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Address Line | 8111 LBJ FWY STE 1300
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City | DALLAS
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State | TX
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Zip | 75251-1392
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Country | US
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Telephone | 972-817-9570
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Fax | 972-817-9580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT2952
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08186
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License Number State | TX
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