Provider Demographics
NPI:1083906945
Name:ANTHONY CUBB MD PA
Entity Type:Organization
Organization Name:ANTHONY CUBB MD PA
Other - Org Name:GREEN OAKS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-973-0885
Mailing Address - Street 1:12033 VETERANS MEMORIAL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1055
Mailing Address - Country:US
Mailing Address - Phone:281-973-0885
Mailing Address - Fax:
Practice Address - Street 1:12033 VETERANS MEMORIAL DR STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1055
Practice Address - Country:US
Practice Address - Phone:281-973-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3775261QU0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE88859Medicare UPIN