Provider Demographics
NPI:1568721181
Name:BRAD HUBBARD MD PA
Entity Type:Organization
Organization Name:BRAD HUBBARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-370-4813
Mailing Address - Street 1:9101 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5927
Mailing Address - Country:US
Mailing Address - Phone:214-370-4813
Mailing Address - Fax:469-375-3844
Practice Address - Street 1:9101 N CENTRAL EXPY
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5927
Practice Address - Country:US
Practice Address - Phone:214-370-4813
Practice Address - Fax:469-375-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN8931OtherTEXAS MEDICAL BOARD PHYSICIAN LICENSE PERMIT