Provider Demographics
NPI:1609845809
Name:HUBBARD, CHARLES JASON (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JASON
Last Name:HUBBARD
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 1:1015 E. 32ND ST.
Mailing Address - Street 2:STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-477-6341
Practice Address - Fax:512-244-1013
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1625213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3950OtherBCBS OF TEXAS
TX158150601Medicaid
TX4792320001Medicare NSC
TX8A7319Medicare ID - Type Unspecified
TX158150601Medicaid