Provider Demographics
NPI:1407185150
Name:GUBIN, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GUBIN
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:POST OFFICE BOX 10
Mailing Address - Street 2:
Mailing Address - City:COOSADA
Mailing Address - State:AL
Mailing Address - Zip Code:36020
Mailing Address - Country:US
Mailing Address - Phone:334-285-3888
Mailing Address - Fax:
Practice Address - Street 1:200 CEDAR DRIVE
Practice Address - Street 2:
Practice Address - City:COOSADA
Practice Address - State:AL
Practice Address - Zip Code:36020
Practice Address - Country:US
Practice Address - Phone:334-285-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.8406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72299Medicare UPIN