Provider Demographics
NPI:1801891288
Name:BUBIS, JEFFREY A (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:BUBIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:813-976-7895
Practice Address - Street 1:4689 US HIGHWAY 17 STE 2-5
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-269-6526
Practice Address - Fax:904-269-6527
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9446207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271941000Medicaid
FL01028OtherBCBS
FL299126OtherAVMED
GA003146502AMedicaid
FL1073888OtherAETNA
FL01028UMedicare PIN
FL01028WMedicare PIN
FLP00279065Medicare PIN
FL271941000Medicaid