Provider Demographics
NPI:1467441493
Name:HUBSHER, MASON I (MD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:I
Last Name:HUBSHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6545 RIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6836
Mailing Address - Country:US
Mailing Address - Phone:727-844-7077
Mailing Address - Fax:727-847-6919
Practice Address - Street 1:6545 RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6836
Practice Address - Country:US
Practice Address - Phone:727-844-7077
Practice Address - Fax:727-847-6919
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379282000Medicaid
FL1266OtherBCBS#
FLF20644Medicare UPIN
FL379282000Medicaid