Provider Demographics
NPI:1396726287
Name:HUBBARD, JEFFERY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7780 N FRESNO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2413
Mailing Address - Country:US
Mailing Address - Phone:559-449-8500
Mailing Address - Fax:559-449-8502
Practice Address - Street 1:7780 N FRESNO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2413
Practice Address - Country:US
Practice Address - Phone:559-449-8500
Practice Address - Fax:559-449-8502
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG62200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G622000Medicaid
CA77040368493612B016OtherCHAMPUS
CA110116923OtherRAILROAD MEDICARE
CA00G622000OtherBLUE CROSS/BLUE SHIELD
CA00G622000OtherBLUE CROSS/BLUE SHIELD
CA00G622000Medicare ID - Type Unspecified