Provider Demographics
NPI:1235851429
Name:HUBBARD, MATTHEW MARCUS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MARCUS
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 DEVONPORT DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1552
Mailing Address - Country:US
Mailing Address - Phone:859-309-2240
Mailing Address - Fax:
Practice Address - Street 1:1365 DEVONPORT DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1552
Practice Address - Country:US
Practice Address - Phone:859-309-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1206188175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist