Provider Demographics
NPI:1861630303
Name:HUBBARD, DONALD L (APN)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-0040
Mailing Address - Country:US
Mailing Address - Phone:432-943-2511
Mailing Address - Fax:432-943-6833
Practice Address - Street 1:400 S IKE AVE
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4703
Practice Address - Country:US
Practice Address - Phone:432-943-2068
Practice Address - Fax:432-943-6833
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX567908OtherSTATE LICENSE