Provider Demographics
NPI:1831182435
Name:HUBBARD, CHRISTOPHER W (DPM)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1905 W HEBRON LN
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7465
Practice Address - Country:US
Practice Address - Phone:502-797-3338
Practice Address - Fax:502-957-1731
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00287213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209790Medicaid
KY0235170001Medicare NSC
U96445Medicare UPIN
KYP00099333Medicare PIN
KYK051351Medicare PIN