Provider Demographics
NPI:1447274154
Name:MCCUBBIN, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MCCUBBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:216 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2036
Mailing Address - Country:US
Mailing Address - Phone:270-885-3937
Mailing Address - Fax:270-886-0107
Practice Address - Street 1:216 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2036
Practice Address - Country:US
Practice Address - Phone:270-885-3937
Practice Address - Fax:270-886-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000074576OtherANTHEM BCBS
KY169424154468OtherHUMANA
KY64242712Medicaid
KYC76072Medicare UPIN
KY64242712Medicaid