Provider Demographics
NPI:1427191071
Name:HUBLER, LEROY N (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:N
Last Name:HUBLER
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:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:3231 S NATIONAL AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-888-6708
Practice Address - Fax:417-890-4143
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000470213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157866748Medicaid
MO9828OtherMO BLUE SHIELD
MO301068425Medicaid
AR81721OtherARK BLUE SHIELD
AR157866748Medicaid
MO301068425Medicaid
T42878Medicare UPIN