Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5937 | KY |
NPI | 1003890237 |
---|---|
Provider Name | Dr. Michael Wayne Hubbard |
First Address | Bowling Green, KY 42101-2648 |
Second Address | Bowling Green, KY 42101-2648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60059375 | (05) | KY |
T54145 | (02) | KY |