Provider Demographics
NPI:1336104447
Name:HUBBUCH, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HUBBUCH
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE. 200-A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7340
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506590Medicaid
KY50005577OtherPASSPORT / NCMA
KY2446880000OtherPASSPORT ADVANTAGE / NCMA
KY64162563Medicaid
KY000028412JOtherHUMANA / NCMA
KY047929OtherSIHO / NCMA
KY1184115OtherCHA / NCMA
KYP00176900OtherRAILROAD MEDICARE
KY000000350760OtherANTHEM / NCMA
C73667Medicare UPIN
KY64162563Medicaid