Ubben Dermatology Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

C-8212 Issued in AR

Legal business name

UBBEN DERMATOLOGY CLINIC

Practice address

5 Cunningham Cor
Bella Vista, AR 72714-3520

Phone

(479) 855-1247

Fax

(479) 855-1249

NPI assigned

May 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth L Ubben, M.D.

Title

Owner

Phone

(479) 855-1247

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1194776906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CUNNINGHAM COR",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727143520",
            "telephone_number": "479-855-1247",
            "fax_number": "479-855-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CUNNINGHAM COR",
            "city": "BELLA VISTA",
            "state": "AR",
            "postal_code": "727143520",
            "telephone_number": "479-855-1247",
            "fax_number": "479-855-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UBBEN DERMATOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "UBBEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-855-1247",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "C-8212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122172001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiny Triumphs Pediatric Therapy LLC
• Jacqueline Tobin, IBCLC
• Melissa Anne Tomlin, MSPT
• Maurice A Torres, COTA
• Binh Tran
• Kenneth L Ubben, M.D.
• Alex Vang, PTA
• Haley Elizabeth Vo, M.D.
• Walgreen Co
• Ian Matthew Warren

• Specialist in Bella Vista, AR
• Providers in Bella Vista, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.