Provider Demographics
NPI:1437417557
Name:HUBBARD, AUSTEN CROSS (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:AUSTEN
Middle Name:CROSS
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8033
Mailing Address - Country:US
Mailing Address - Phone:910-398-2654
Mailing Address - Fax:
Practice Address - Street 1:7103 11TH AVE
Practice Address - Street 2:
Practice Address - City:N TOPSAIL BEACH
Practice Address - State:NC
Practice Address - Zip Code:28460-8033
Practice Address - Country:US
Practice Address - Phone:910-398-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman