Jimmy Dean Chubbuck, M.D. – Family Medicine Physician

Key facts

NPI: 1285857136
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 20387 (WA)
Practice address: 2120 Ryan Rd
Buckley, WA 98321-9115
Phone: (360) 829-1111
NPI assigned: Apr 10, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Rainier State School Intellectual Disabilities Intermediate Care Facility · Buckley, WA · NPI 1164547626

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
20387	WA	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Rainier State School		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	20387	WA	Yes

Addresses

Primary practice location

2120 Ryan Rd
Buckley, WA 98321-9115

Mailing address

2096 Ryan Rd
Buckley, WA 98321-9115
Phone (360) 829-6304

Other identifiers

Identifier	Type	State	Issuer
1189107	Medicaid	WA

Other providers in Buckley, WA

All providers in Buckley, WA · Family Medicine Physician in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.