Provider Demographics
NPI:1457303703
Name:LUBIN, JEFFREY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:LUBIN
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 1:23811 CANELLA CT
Mailing Address - Street 2:#927
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1522
Mailing Address - Country:US
Mailing Address - Phone:775-247-2733
Mailing Address - Fax:281-783-2556
Practice Address - Street 1:10 HARBOR BLVD
Practice Address - Street 2:#927
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-7374
Practice Address - Country:US
Practice Address - Phone:570-760-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026079E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001033178Medicaid
PA001033178Medicaid
PAC30774Medicare UPIN