Provider Demographics
NPI:1578573390
Name:TUBBS, RICARDO MIGUEL (IDC)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:MIGUEL
Last Name:TUBBS
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 1:1034 ANN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2204
Mailing Address - Country:US
Mailing Address - Phone:757-295-0725
Mailing Address - Fax:
Practice Address - Street 1:1001 HOLCOMB RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2415
Practice Address - Country:US
Practice Address - Phone:757-953-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman