Individual
DR. MARK J KUBALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5235 MERLOT DR, BEAUMONT, TX 77706-2577
(409) 781-8426
Mailing address
5235 MERLOT DR, BEAUMONT, TX 77706-2577
(409) 781-8426
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C0720
TX
207T00000X
Neurological Surgery Physician
C0720
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020HD
GROUP BCBS
TX
05
—
125802205
—
TX
01
—
140007873
RAILROAD MEDICARE
TX
05
—
148913001
—
TX
01
—
2824444001
CIGNA
TX
01
—
4364874
AETNA
TX
01
—
8F3760
BCBS
TX
01
—
A003
TRICARE CHAMPUS
TX
Enumeration date
07/21/2005
Last updated
09/12/2023
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