Provider Demographics
NPI: | 1144273103 |
---|---|
Name: | SUBORA, ADRIEN SOWLE (PA-C) |
Entity type: | Individual |
Prefix: | MR |
First Name: | ADRIEN |
Middle Name: | SOWLE |
Last Name: | SUBORA |
Suffix: | |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1515 HOLCOMBE BLVD |
Mailing Address - Street 2: | MD ANDERSON CANCER CENTER - DEPARTMENT OF LEUKEMIA |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77030-4000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-792-6161 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1515 HOLCOMBE BLVD |
Practice Address - Street 2: | MD ANDERSON CANCER CENTER - DEPARTMENT OF LEUKEMIA |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77030-4000 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-792-6161 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-18 |
Last Update Date: | 2008-05-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |