Provider Demographics
NPI:1033114335
Name:TUBBS, CARL B (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:B
Last Name:TUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:STE 190
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-794-1111
Mailing Address - Fax:303-347-1341
Practice Address - Street 1:11960 LIONESS WAY
Practice Address - Street 2:STE 190
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5640
Practice Address - Country:US
Practice Address - Phone:303-794-1111
Practice Address - Fax:303-347-1341
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180015058OtherRAILROAD MEDICARE
WI180046282OtherRAILROAD MEDICARE
MN531263900Medicaid
MN180015058OtherRAILROAD MEDICARE
F23114Medicare UPIN
MN180000426Medicare PIN