Individual
DR. JUSTIN F BUBOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 231-3102
(573) 231-3723
Mailing address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 231-3102
(573) 231-3723
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R2H02
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209722503
—
MO
Enumeration date
01/11/2006
Last updated
10/08/2021
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