1912915455 NPI number — MR. JEFFREY ALAN LUBBERS P.T.

Table of content: MR. JEFFREY ALAN LUBBERS P.T. (NPI 1912915455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912915455 NPI number — MR. JEFFREY ALAN LUBBERS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUBBERS
Provider First Name:
JEFFREY
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912915455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3116 COMSTOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27604-3507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-872-6167
Provider Business Mailing Address Fax Number:
919-872-6167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 PEMBERTON HILL RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-4265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
10-367-0866
Provider Business Practice Location Address Fax Number:
919-367-0866
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1119 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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