Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101256217 | VA |
NPI | 1700100286 |
---|---|
Provider Name | Matthew A Hubbard |
First Address | Abingdon, VA 24212-1328 |
Second Address | Abingdon, VA 24210-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2010 |
Last Update Date | 09/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1700100286 | (05) | VA |
VVD656A | (02) | VA |