Provider Demographics
NPI:1457323453
Name:HUBBARD, KARL WINSOR (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:WINSOR
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:46 SERGEANT PRENTISS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-442-9654
Mailing Address - Fax:601-442-9618
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:954-399-4645
Practice Address - Fax:855-855-2792
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2016-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9500291174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890176UMedicaid
NCC76291Medicare UPIN
NC2318635Medicare ID - Type UnspecifiedMEDICARE