Provider Demographics
NPI:1497462618
Name:JUBERT, DANIEL SR
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:JUBERT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8603
Mailing Address - Country:US
Mailing Address - Phone:214-635-9338
Mailing Address - Fax:
Practice Address - Street 1:250 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8603
Practice Address - Country:US
Practice Address - Phone:214-635-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver