Provider Demographics
NPI:1407059405
Name:KUBIN, ANDREW LEE (PA-C, LAT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEE
Last Name:KUBIN
Suffix:
Gender:M
Credentials:PA-C, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3827
Mailing Address - Country:US
Mailing Address - Phone:972-923-2440
Mailing Address - Fax:
Practice Address - Street 1:411 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3827
Practice Address - Country:US
Practice Address - Phone:972-923-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29522255A2300X
TXPA08186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer