Provider Demographics
NPI:1184629438
Name:LUBY, MAUREEN T (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:T
Last Name:LUBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N. CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2156
Mailing Address - Country:US
Mailing Address - Phone:214-827-7460
Mailing Address - Fax:214-826-6858
Practice Address - Street 1:4144 N. CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 435
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8044
Practice Address - Country:US
Practice Address - Phone:214-827-7460
Practice Address - Fax:214-826-6858
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3384207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045756603Medicaid
TXH15945Medicare UPIN
TX045756603Medicaid