Provider Demographics
NPI:1922113505
Name:TAUBE, JUSTINA PEPPLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINA
Middle Name:PEPPLE
Last Name:TAUBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUSTINA
Other - Middle Name:PEPPLE
Other - Last Name:TAUBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25410 I-45 NORTH
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1351
Mailing Address - Country:US
Mailing Address - Phone:281-367-1414
Mailing Address - Fax:281-363-5686
Practice Address - Street 1:25410 I-45 NORTH FWY
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1351
Practice Address - Country:US
Practice Address - Phone:281-367-1414
Practice Address - Fax:281-363-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4553207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136962112Medicaid
8W4460OtherBLUE CROSS BLUE SHIELD
TX136962112Medicaid
TX00435QMedicare PIN