Provider Demographics
NPI:1407059405
Name:KUBIN, ANDREW LEE (PA-C, LAT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LEE
Last Name:KUBIN
Suffix:
Gender:M
Credentials:PA-C, LAT
Other - Prefix:
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Mailing Address - Street 1:8111 LBJ FWY STE 1300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1392
Mailing Address - Country:US
Mailing Address - Phone:972-817-9570
Mailing Address - Fax:972-817-9580
Practice Address - Street 1:2460 N INTERSTATE 35E
Practice Address - Street 2:STE 215
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-817-9570
Practice Address - Fax:972-817-9580
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT29522255A2300X
TXPA08186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer