Provider Demographics
NPI:1063660371
Name:LUBBE, JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:LUBBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 GLENN MITCHELL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0048
Mailing Address - Country:US
Mailing Address - Phone:757-507-0305
Mailing Address - Fax:757-507-0306
Practice Address - Street 1:1950 GLENN MITCHELL DR STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0048
Practice Address - Country:US
Practice Address - Phone:757-507-0305
Practice Address - Fax:757-507-0306
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLCH9564111N00000X
VA0102206513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No111N00000XChiropractic ProvidersChiropractor