Provider Demographics
NPI:1669468583
Name:KUBEK, PERRY B (DO)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:B
Last Name:KUBEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5665 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1513
Mailing Address - Country:US
Mailing Address - Phone:717-569-7011
Mailing Address - Fax:717-569-8694
Practice Address - Street 1:5970 LEMON ST
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1316
Practice Address - Country:US
Practice Address - Phone:717-569-7011
Practice Address - Fax:717-569-8694
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010636L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA71741 S1QCOtherGEISINGER HEALTH PLAN
PA561080OtherHIGHMARK BLUE SHIELD
PA1130425OtherAETNA HMO
PA7291120OtherAETNA NON-HMO
PAH14465OtherHEALTH ASSURANCE
PAP002562OtherGATEWAY HEALTH PLAN
PA0017934970003Medicaid
PA50014740OtherCAPITAL BLUE CROSS
PA71741 S1QCOtherGEISINGER HEALTH PLAN
PAH14465OtherHEALTH ASSURANCE