Provider Demographics
NPI:1720177504
Name:HUBERT, STANLEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:HUBERT
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 1:700 E SPRING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2926
Mailing Address - Country:US
Mailing Address - Phone:945-945-7536
Mailing Address - Fax:812-945-7542
Practice Address - Street 1:700 E SPRING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2926
Practice Address - Country:US
Practice Address - Phone:945-945-7536
Practice Address - Fax:812-945-7542
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057450A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN61-1091357OtherTAX ID
IN100115990AMedicaid
IN200456770Medicaid
ING79096Medicare UPIN
IN200456770Medicaid