Provider Demographics
NPI:1508157280
Name:HUBBUCH, TRAVIS MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MATTHEW
Last Name:HUBBUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 SHAGBARK TRL
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9118
Mailing Address - Country:US
Mailing Address - Phone:502-548-5196
Mailing Address - Fax:
Practice Address - Street 1:360 PLAZA DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2952
Practice Address - Country:US
Practice Address - Phone:812-372-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001179A213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program