Provider Demographics
NPI:1710960018
Name:TUBON, JOHN CALDERON (NCCPA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CALDERON
Last Name:TUBON
Suffix:
Gender:M
Credentials:NCCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C CO 168TH MED BN (AS)
Mailing Address - Street 2:UNIT#15190
Mailing Address - City:APO
Mailing Address - State:PYONGTAEK
Mailing Address - Zip Code:96271
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:C CO 168TH MED BN (AS)
Practice Address - Street 2:UNIT#15190
Practice Address - City:APO
Practice Address - State:PYONGTAEK
Practice Address - Zip Code:96271
Practice Address - Country:KR
Practice Address - Phone:753-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant