Provider Demographics
NPI:1982657631
Name:HUBER, JONATHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:HUBER
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 1:11101 S CROWN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8792
Mailing Address - Country:US
Mailing Address - Phone:561-795-9150
Mailing Address - Fax:561-798-7700
Practice Address - Street 1:11101 S CROWN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8792
Practice Address - Country:US
Practice Address - Phone:561-795-9150
Practice Address - Fax:561-798-7700
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 395782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0420166-00Medicaid
D 64024Medicare UPIN
FL96896Medicare PIN
FL0420166-00Medicaid