Provider Demographics
NPI:1841392081
Name:BUBIS, PERRY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:ROBERT
Last Name:BUBIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1429 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#210
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-495-6108
Mailing Address - Fax:805-495-6196
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD
Practice Address - Street 2:#210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-495-6108
Practice Address - Fax:805-495-6196
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13838208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery