Provider Demographics
NPI:1366447336
Name:HULBERT, LAURA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RUTH
Last Name:HULBERT
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 1:2900 LEMAY FERRY ROAD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125
Mailing Address - Country:US
Mailing Address - Phone:314-487-5227
Mailing Address - Fax:314-487-2619
Practice Address - Street 1:2900 LEMAY FERRY RD
Practice Address - Street 2:SUITE 228
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-487-5227
Practice Address - Fax:314-487-2619
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
MOR4E88207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10502Medicare UPIN