Basic Information
| Provider Information | |||||||||
| NPI: | 1710965322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUBANE | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | VELEZ | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 SCHENCK ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044809344 | ||||||||
| FaxNumber: | 7044843260 | ||||||||
| Practice Location | |||||||||
| Address1: | 808 SCHENCK ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044809344 | ||||||||
| FaxNumber: | 7044843260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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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 | 207Q00000X | 9701430 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 891081W | 05 | NC | MEDICAID |