Individual
MARK CLINTON LUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18555 N 79TH AVE STE B108, GLENDALE, AZ 85308-8372
(888) 705-8558
(480) 776-0025
Mailing address
102 WOODMONT BLVD STE 600, NASHVILLE, TN 37205-5250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26967
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
539869
—
AZ
01
—
Z276049
MEDICARE
AZ
Enumeration date
01/20/2006
Last updated
08/07/2024
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