Provider Demographics
NPI:1659325686
Name:ZUBER, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:ZUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1107
Mailing Address - Country:US
Mailing Address - Phone:919-562-9410
Mailing Address - Fax:919-562-2948
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7375
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:919-562-2948
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30266207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016F1OtherBCBSNC GROUP NUMBER
NCD0263OtherMEDCOST PROVIDER NUMBER
NC0871437OtherCIGNA
NCA9021OtherMEDCOST GROUP NUMBER
NC34D1018993OtherCLIA WAIVED NUMBER
NC30266OtherNC LICENSE
NC89016F1Medicaid
NC89937OtherBCBSNC PROVIDER NUMBER
NC20-0205133OtherTAX ID, UNITED HEALTHCARE
NC8989937Medicaid
NC56142OtherHEALTHCARE SYSTEMS
NC34D1018993OtherCLIA WAIVED NUMBER
NCA9021OtherMEDCOST GROUP NUMBER
NC56142OtherHEALTHCARE SYSTEMS