Provider Demographics
NPI:1114990850
Name:JUBA, DANIEL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RICHARD
Last Name:JUBA
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 1:340 HULSE RD
Mailing Address - Street 2:INTERNAL MEDICINE CODE 324
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1047
Mailing Address - Country:US
Mailing Address - Phone:850-452-2257
Mailing Address - Fax:
Practice Address - Street 1:340 HULSE RD
Practice Address - Street 2:INTERNAL MEDICINE CODE 324
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1047
Practice Address - Country:US
Practice Address - Phone:850-452-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F23674Medicare UPIN
14820Medicare ID - Type Unspecified