Provider Demographics
NPI:1104812270
Name:TUBBS, JOHN D (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:TUBBS
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:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:NE
Mailing Address - Zip Code:68780-0377
Mailing Address - Country:US
Mailing Address - Phone:402-924-3777
Mailing Address - Fax:402-924-3776
Practice Address - Street 1:110 W. 2ND ST.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:NE
Practice Address - Zip Code:68780-0070
Practice Address - Country:US
Practice Address - Phone:402-924-3777
Practice Address - Fax:402-924-3776
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22198261QM1300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE236735OtherMIDLANDS CHOICE
NE00187OtherBCBS
NE00187OtherBCBS
NE281620Medicare PIN