Provider Demographics
NPI:1649716002
Name:HUBBARD, JOHN LEONARD JR
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEONARD
Last Name:HUBBARD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 GORDY ST
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 GORDY STREET
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-847-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine