Individual
DR. CORBY ALAN BUBP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
10293 N MERIDIAN ST, INDIANAPOLIS, IN 46290-1123
(317) 581-2288
(317) 581-2295
Mailing address
10291 N MERIDIAN ST, STE 310, INDIANAPOLIS, IN 46290-1083
(317) 581-2288
(317) 581-2295
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20042024
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200504340
—
IN
Enumeration date
08/02/2006
Last updated
12/09/2019
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