Provider Demographics
NPI:1184800971
Name:TUBBS, RICKY BRIAN (DO)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:BRIAN
Last Name:TUBBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 DECATUR HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2384
Mailing Address - Country:US
Mailing Address - Phone:205-608-8199
Mailing Address - Fax:205-608-8195
Practice Address - Street 1:2215 DECATUR HWY STE 101
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2384
Practice Address - Country:US
Practice Address - Phone:205-608-8199
Practice Address - Fax:205-608-8195
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9639207L00000X
AL1004207L00000X
ALDO1004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL176152Medicaid
AL10205I7957OtherMEDICARE