Provider Demographics
NPI:1114934825
Name:HUBBARD, DAWN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PORTAGE TRAIL EXT W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3613
Mailing Address - Country:US
Mailing Address - Phone:330-928-3111
Mailing Address - Fax:330-928-2843
Practice Address - Street 1:265 PORTAGE TRAIL EXT W
Practice Address - Street 2:SUITE 200
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3613
Practice Address - Country:US
Practice Address - Phone:330-928-3111
Practice Address - Fax:330-928-2843
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071199H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034015Medicaid
OH0858792Medicare PIN
OH2034015Medicaid