Provider Demographics
NPI:1831171792
Name:HUBBELL, CARL J (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9356 WINZER RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-8692
Mailing Address - Country:US
Mailing Address - Phone:409-981-9067
Mailing Address - Fax:409-981-9086
Practice Address - Street 1:3127 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4609
Practice Address - Country:US
Practice Address - Phone:409-899-1433
Practice Address - Fax:409-981-9086
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X6082OtherBCBS
TX8J7593Medicare PIN
TX87030KMedicare ID - Type Unspecified
TXE70063Medicare UPIN