Provider Demographics
NPI:1942237797
Name:HUBER, DOUGLAS H (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:HUBER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1 E CLARK BASS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-426-1800
Mailing Address - Fax:918-421-6824
Practice Address - Street 1:19 KIAMICHI RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-5228
Practice Address - Country:US
Practice Address - Phone:918-452-2330
Practice Address - Fax:918-452-2335
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK87363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100710530BMedicaid
OK100229620AMedicare ID - Type Unspecified
OK100710530BMedicaid