Provider Demographics
NPI:1982645594
Name:HUBER, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:HUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-4538
Mailing Address - Fax:605-328-4531
Practice Address - Street 1:521 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3142
Practice Address - Country:US
Practice Address - Phone:605-945-5560
Practice Address - Fax:605-224-0369
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD2294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995175OtherBCBS
SD201750841OtherTAX ID
SD27032OtherSVHP
SD5601844Medicaid
SD2294OtherDAKOTACARE
SD2294OtherDAKOTACARE
SD4995175OtherBCBS