Individual
GARY BUBLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 519-1604
(401) 272-0538
Mailing address
125 WHIPPLE ST, STE 3, PROVIDENCE, RI 02908-3258
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD07723
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004258
BC BSRI
RI
01
—
007005644
MEDICARE
RI
01
—
12/29/2008
TUFTS
RI
01
—
1760406698
NPI
RI
01
—
3184684
MEDICAID
MA
05
—
9006562
—
RI
01
—
930043404
RAILROAD MEDICARE
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
03/10/2016
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