Provider Demographics
NPI:1568523595
Name:LUBETICH, JOHN FRANCIS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:LUBETICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028423207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1065747Medicaid
WA192575000OtherOWCP
WALU0376OtherREGENCE
WA911577098OtherUNIFORM MEDICAL PLAN
WA911577098OtherPREMERA BLUE CROSS
WA911577098-04OtherKITSAP PHYSICIANS SERVICE
WA013194010OtherGROUP HEALTH COOPERATIVE
WA38303OtherLABOR AND INDUSTRIES
F00210Medicare UPIN
000200948Medicare ID - Type Unspecified