Provider Demographics
NPI:1821592684
Name:KUBAC, JIRI FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JIRI
Middle Name:FRANCIS
Last Name:KUBAC
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 1:351 N BUFFALO DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0301
Mailing Address - Country:US
Mailing Address - Phone:702-505-4230
Mailing Address - Fax:702-505-4231
Practice Address - Street 1:351 N BUFFALO DR STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0301
Practice Address - Country:US
Practice Address - Phone:702-505-4230
Practice Address - Fax:702-505-4231
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV21157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1821592684Medicaid