Provider Demographics
NPI:1063772218
Name:LUBAN, HENRY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALLEN
Last Name:LUBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 SCENIC WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4974
Mailing Address - Country:US
Mailing Address - Phone:907-349-2205
Mailing Address - Fax:
Practice Address - Street 1:1704 SCENIC WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4974
Practice Address - Country:US
Practice Address - Phone:907-349-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine