Basic Information
| Provider Information | |||||||||
| NPI: | 1508191990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUBMAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D., ABPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | WHASC, 1100 WILFORD HALL LOOP | ||||||||
| Address2: | |||||||||
| City: | JBSA-LACKLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78236 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | WHASC, 1100 WILFORD HALL LOOP | ||||||||
| Address2: | |||||||||
| City: | JBSA-LACKLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2009 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1766 | AL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.