Provider Demographics
NPI:1568452720
Name:HUEBNER, MARY FREERICKS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FREERICKS
Last Name:HUEBNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6107
Mailing Address - Country:US
Mailing Address - Phone:541-773-1435
Mailing Address - Fax:541-858-6828
Practice Address - Street 1:1411 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6107
Practice Address - Country:US
Practice Address - Phone:541-773-1435
Practice Address - Fax:541-858-6828
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00752363A00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
970023131Medicare PIN
P35798Medicare UPIN
109906Medicare PIN