Individual
DR. IVAN BUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2610 KEISER BLVD, WYOMISSING, PA 19610-3333
(610) 775-3316
(610) 796-2962
Mailing address
2610 KEISER BLVD, WYOMISSING, PA 19610-3333
(610) 775-3316
(610) 796-2962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD040616L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012539300007
—
PA
Enumeration date
09/06/2005
Last updated
04/11/2011
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