Provider Demographics
NPI:1184726622
Name:HUBBARD, REX (MD)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:
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 1:4600 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6902
Mailing Address - Country:US
Mailing Address - Phone:337-521-9239
Mailing Address - Fax:337-521-9268
Practice Address - Street 1:4600 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6902
Practice Address - Country:US
Practice Address - Phone:337-521-9239
Practice Address - Fax:337-521-9268
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200828207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02871338Medicaid
LA1013307Medicaid
LA1013307Medicaid
P00419764Medicare PIN
TNB03218Medicare UPIN