Provider Demographics
NPI:1457301004
Name:CUBIN, FREDERICK W III (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:CUBIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:419 S WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2951
Mailing Address - Country:US
Mailing Address - Phone:307-265-1620
Mailing Address - Fax:307-237-1074
Practice Address - Street 1:419 S WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2951
Practice Address - Country:US
Practice Address - Phone:307-265-1620
Practice Address - Fax:307-237-1074
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY8400A2085R0202X
WY8400-A2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW23441Medicare PIN