Provider Demographics
NPI:1184683625
Name:GREGORY TUBRE, MD, APMC
Entity Type:Organization
Organization Name:GREGORY TUBRE, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-271-2350
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:479-271-2350
Mailing Address - Fax:479-271-0805
Practice Address - Street 1:811 SE 28TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4268
Practice Address - Country:US
Practice Address - Phone:479-271-2350
Practice Address - Fax:479-271-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F310OtherARK BLUE CROSS
AR5F310Medicare ID - Type Unspecified