Provider Demographics
NPI:1013910033
Name:HUBBARD, GARRICK P (MD)
Entity Type:Individual
Prefix:
First Name:GARRICK
Middle Name:P
Last Name:HUBBARD
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 1:11590 N MERIDIAN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4599
Mailing Address - Country:US
Mailing Address - Phone:317-708-2839
Mailing Address - Fax:
Practice Address - Street 1:11590 N MERIDIAN ST STE 400
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4599
Practice Address - Country:US
Practice Address - Phone:317-708-2839
Practice Address - Fax:317-708-2877
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000352618OtherANTHEM PROVIDER NUMBER
IN000000352618OtherANTHEM PROVIDER NUMBER
INH97735Medicare UPIN