MEDICARE: DR. RICHARD JAY TUBB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD042616E	PA

General Provider Information

NPI Number	:	1225000243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JAY TUBB MD

Provider Business Mailing Address
First Line	:	1600 PENNSYLVANIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20502-0001
Country	:	US
Telephone Number	:	202-757-2481
Fax Number	:	202-757-2483

Provider Business Practice Location Address
First Line	:	1600 PENNSYLVANIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20502-0001
Country	:	US
Telephone Number	:	202-757-2481
Fax Number	:	202-757-2483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	07/08/2007

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