Provider Demographics
NPI:1821086760
Name:HUBBELL, GEORGE PEYTON (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PEYTON
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 OZARK CARE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3016
Mailing Address - Country:US
Mailing Address - Phone:573-348-6101
Mailing Address - Fax:573-348-6324
Practice Address - Street 1:1055 OZARK CARE DR
Practice Address - Street 2:SUITE B
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3016
Practice Address - Country:US
Practice Address - Phone:573-348-6101
Practice Address - Fax:573-348-6324
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2P55207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821086760Medicaid
MO431560263OtherTRICARE WEST
AR182724001Medicaid
MOP00825494OtherRAILROAD MEDICARE-CB9013
MOP00825494OtherRAILROAD MEDICARE-CB9013
MO1821086760Medicaid
MO132680126Medicare PIN