Provider Demographics
NPI:1649224619
Name:KUBIER, MARTIN J (PA)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:KUBIER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4612
Mailing Address - Country:US
Mailing Address - Phone:580-436-7101
Mailing Address - Fax:580-436-4447
Practice Address - Street 1:217 W SMITH
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:OK
Practice Address - Zip Code:74872
Practice Address - Country:US
Practice Address - Phone:580-759-2336
Practice Address - Fax:580-436-4447
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200042500AMedicaid
OKR93738Medicare UPIN
OK242416203Medicare ID - Type Unspecified
OK200042500AMedicaid