Provider Demographics
NPI:1831164425
Name:KUBICEK, JOSEPH H (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:KUBICEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MIDNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-9269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-7844
Practice Address - Fax:719-526-7132
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00582363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012292OtherNCCPA