Provider Demographics
NPI:1457534257
Name:HUBBARD, GREGORY (NMI) (PA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:(NMI)
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2620 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3102
Mailing Address - Country:US
Mailing Address - Phone:415-746-1940
Mailing Address - Fax:415-746-1941
Practice Address - Street 1:1375 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2621
Practice Address - Country:US
Practice Address - Phone:415-746-1940
Practice Address - Fax:415-746-1941
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2016-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12349PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12349PAOtherSTATE LICENSE