MEDICARE: WILLIAM D CUBIDES 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	207P00000X	Emergency Medicine Physician	ME45775	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62638	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1356344501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM D CUBIDES MD

Provider Business Mailing Address
First Line	:	1405 CREEK NINE DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-8050
Country	:	US
Telephone Number	:	941-525-7221
Fax Number	:	941-240-8958

Provider Business Practice Location Address
First Line	:	1405 CREEK NINE DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-8050
Country	:	US
Telephone Number	:	941-525-7221
Fax Number	:	941-240-8958

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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