Provider Demographics
NPI:1063605798
Name:BUBAN, CINDY KIEL (PA)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:KIEL
Last Name:BUBAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LYNN
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1721 BIRMINGHAM DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4082
Mailing Address - Country:US
Mailing Address - Phone:979-696-8000
Mailing Address - Fax:979-696-8100
Practice Address - Street 1:1721 BIRMINGHAM DR
Practice Address - Street 2:SUITE 204
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4081
Practice Address - Country:US
Practice Address - Phone:979-696-8000
Practice Address - Fax:979-696-8100
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS72790Medicare UPIN