Provider Demographics
NPI:1376544254
Name:HUEBNER, DAVID B (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 BISHOP RD SW STE 101
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7303
Mailing Address - Country:US
Mailing Address - Phone:360-338-0004
Mailing Address - Fax:360-515-0744
Practice Address - Street 1:5210 CORPORATE CENTER CT SE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5952
Practice Address - Country:US
Practice Address - Phone:360-764-8293
Practice Address - Fax:360-706-2560
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60211761213ES0103X
MT87213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390780Medicaid
MT0390780Medicaid
T60214Medicare UPIN