Individual
DR. GARY A BUBAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
517 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-5457
(605) 384-3057
Mailing address
PO BOX 190, WAGNER, SD 57380-0190
(605) 384-5457
(605) 384-3057
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1400
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009387
BLUE SHIELD
SD
05
—
6001080
—
SD
Enumeration date
08/03/2005
Last updated
06/16/2008
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