Provider Demographics
NPI:1326307604
Name:HUBACKER, ALLAN STUART (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:STUART
Last Name:HUBACKER
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 1:623 KOKO ISLE CIR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1814
Mailing Address - Country:US
Mailing Address - Phone:808-394-0936
Mailing Address - Fax:
Practice Address - Street 1:623 KOKO ISLE CIR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1814
Practice Address - Country:US
Practice Address - Phone:808-269-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH-1596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33819Medicare UPIN