Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 35-04-1078 | OH |
NPI | 1043291917 |
---|---|
Provider Name | Dr. Susan Lee Hubbell |
First Address | Lima, OH 45805-2738 |
Second Address | Lima, OH 45805-2738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 19/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000120843 | BLUE SHIELD (01) | |
0432277 | (05) | OH |
250001154 | RAILROAD MEDICARE (01) | |
341526576 00 | WC (01) | OH |
A79677 | (02) |