Provider Demographics
NPI:1013212646
Name:TERRY D. TUBB, MD,PA
Entity Type:Organization
Organization Name:TERRY D. TUBB, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:432-683-7821
Mailing Address - Street 1:1304 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6176
Mailing Address - Country:US
Mailing Address - Phone:432-683-7821
Mailing Address - Fax:432-683-8915
Practice Address - Street 1:1304 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6176
Practice Address - Country:US
Practice Address - Phone:432-683-7821
Practice Address - Fax:432-683-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB130962Medicare PIN