Provider Demographics
NPI:1437371812
Name:HUBBARD, ROBERT BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRENT
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12888 PORCUPINE PASS
Mailing Address - Street 2:
Mailing Address - City:LAVA HOT SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83246-0834
Mailing Address - Country:US
Mailing Address - Phone:208-776-5385
Mailing Address - Fax:208-776-5385
Practice Address - Street 1:12888 PORCUPINE PASS
Practice Address - Street 2:
Practice Address - City:LAVA HOT SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83246-0834
Practice Address - Country:US
Practice Address - Phone:208-776-5385
Practice Address - Fax:208-776-5385
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-28472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology