Provider Demographics
NPI:1811996697
Name:HUBANKS, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HUBANKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1370 FOOTHILL BLVD
Mailing Address - Street 2:#100
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2150
Mailing Address - Country:US
Mailing Address - Phone:818-952-1155
Mailing Address - Fax:818-952-2632
Practice Address - Street 1:1370 FOOTHILL BLVD
Practice Address - Street 2:#100
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2150
Practice Address - Country:US
Practice Address - Phone:818-952-1155
Practice Address - Fax:818-952-2632
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2008-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG10884207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040001519OtherRAILROAD MEDICARE
CAG10884Medicare PIN
CAA38111Medicare UPIN