Provider Demographics
NPI:1457450249
Name:HUBBARD, LAURA MILES (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MILES
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MD
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 82
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:NC
Mailing Address - Zip Code:28635
Mailing Address - Country:US
Mailing Address - Phone:336-696-2711
Mailing Address - Fax:336-696-2829
Practice Address - Street 1:5229 ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:NC
Practice Address - Zip Code:28635-0082
Practice Address - Country:US
Practice Address - Phone:336-696-2711
Practice Address - Fax:336-696-2829
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8944789Medicaid
G19938Medicare UPIN
NC2804293Medicare ID - Type UnspecifiedGROUP
NC2219341Medicare ID - Type UnspecifiedINDIVIDUAL
NC8944789Medicaid