Provider Demographics
NPI:1548237928
Name:CHUBB, ANDREW THOMAS (IDC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THOMAS
Last Name:CHUBB
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCM CREW IMPLICIT
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09501
Mailing Address - Country:US
Mailing Address - Phone:361-385-6226
Mailing Address - Fax:
Practice Address - Street 1:MCM CREW IMPLICIT
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09501
Practice Address - Country:US
Practice Address - Phone:361-385-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman