Provider Demographics
NPI:1750470654
Name:HUEBNER, KERMIT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:DAVID
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KERMIT
Other - Middle Name:
Other - Last Name:HUEBNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PAT
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-0770
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23785207P00000X
IN01053936A207P00000X
TXN0110207P00000X
PAMD447669207P00000X
OH120893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine