Provider Demographics
NPI:1033268461
Name:OVERTON, JOHN HUBBARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUBBARD
Last Name:OVERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16031 DEBLIN SQ
Mailing Address - Street 2:HWY 51 SOUTH
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-386-9911
Mailing Address - Fax:985-386-7879
Practice Address - Street 1:16031 DEBLIN SQ
Practice Address - Street 2:HWY 51 SOUTH
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-386-9911
Practice Address - Fax:985-386-7879
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA9305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301701Medicaid
LA1301701Medicaid