Provider Demographics
NPI:1336181064
Name:PETER ALAN TUBY MD PA
Entity Type:Organization
Organization Name:PETER ALAN TUBY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-496-0303
Mailing Address - Street 1:5258 LINTON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6540
Mailing Address - Country:US
Mailing Address - Phone:561-496-0303
Mailing Address - Fax:561-496-7163
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-496-0303
Practice Address - Fax:561-496-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY869AOtherMEDICARE ID-TYPE UNSPECIFIED
FLD60524Medicare UPIN
FL93624Medicare ID - Type Unspecified