Provider Demographics
NPI:1801008065
Name:PAUL F WUBBENA JR MD PA
Entity Type:Organization
Organization Name:PAUL F WUBBENA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WUBBENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-378-2880
Mailing Address - Street 1:11267 HARBOUR WOODS RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1504
Mailing Address - Country:US
Mailing Address - Phone:904-378-2880
Mailing Address - Fax:904-646-7997
Practice Address - Street 1:11267 HARBOUR WOODS RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1504
Practice Address - Country:US
Practice Address - Phone:904-378-2880
Practice Address - Fax:904-646-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty