Provider Demographics
NPI:1275319139
Name:MARK J KUBALA MD PA
Entity Type:Organization
Organization Name:MARK J KUBALA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-781-8426
Mailing Address - Street 1:5235 MERLOT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2577
Mailing Address - Country:US
Mailing Address - Phone:409-781-8426
Mailing Address - Fax:
Practice Address - Street 1:5235 MERLOT DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2577
Practice Address - Country:US
Practice Address - Phone:409-781-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty