Provider Demographics
NPI:1306923750
Name:TUBER, JACK STEVEN (DO)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:STEVEN
Last Name:TUBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-424-7967
Mailing Address - Fax:
Practice Address - Street 1:6818 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5025
Practice Address - Country:US
Practice Address - Phone:623-566-3550
Practice Address - Fax:623-566-3573
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2373207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease