Provider Demographics
NPI:1326083361
Name:HUBBARD, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7329
Mailing Address - Country:US
Mailing Address - Phone:307-634-7711
Mailing Address - Fax:
Practice Address - Street 1:800 E 20TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3859
Practice Address - Country:US
Practice Address - Phone:307-634-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4525A2085R0202X
CO294682085R0202X
NE212662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91045252Medicaid
WY306014OtherBCBS WYOMING
WY104805800Medicaid
WY306014OtherBCBS WYOMING
E30495Medicare UPIN
CO91045252Medicaid