Provider Demographics
NPI:1700867892
Name:HUBL, BRYAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:A
Last Name:HUBL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:A
Other - Last Name:HUBL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-2019
Mailing Address - Country:US
Mailing Address - Phone:402-768-7203
Mailing Address - Fax:402-768-4697
Practice Address - Street 1:120 PARK AVE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:NE
Practice Address - Zip Code:68370-2019
Practice Address - Country:US
Practice Address - Phone:402-768-7203
Practice Address - Fax:402-768-4697
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH71989Medicare UPIN
NE278180Medicare ID - Type Unspecified