Provider Demographics
NPI:1427031640
Name:HUBBARD, RONALD COLLINS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:COLLINS
Last Name:HUBBARD
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2600 TOWER DR STE 309
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5783
Practice Address - Country:US
Practice Address - Phone:318-966-6575
Practice Address - Fax:318-966-6586
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA018486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377058Medicaid
LA018486OtherSTATE LICENSE #
BH0160717OtherDEA #
LA018486OtherSTATE LICENSE #
BH0160717OtherDEA #