Provider Demographics
NPI:1801416771
Name:CUBBEDGE, DANIEL LOUIS
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LOUIS
Last Name:CUBBEDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1052
Mailing Address - Country:US
Mailing Address - Phone:760-605-6544
Mailing Address - Fax:
Practice Address - Street 1:1155 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1052
Practice Address - Country:US
Practice Address - Phone:760-605-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management