Provider Demographics
NPI:1184695538
Name:QUBTY, JOHNNY A (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:A
Last Name:QUBTY
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 21ST ST
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1229
Mailing Address - Country:US
Mailing Address - Phone:806-771-7877
Mailing Address - Fax:806-771-7474
Practice Address - Street 1:3601 21ST ST
Practice Address - Street 2:SUITE 3-A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1229
Practice Address - Country:US
Practice Address - Phone:806-771-7877
Practice Address - Fax:806-771-7474
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2703208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070LPOtherBLUE CROSS BLUE SHIELD
TX130361208Medicaid
TX050018039OtherRAILROAD MEDICARE
TX0070LPOtherBLUE CROSS BLUE SHIELD