Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 267550 | MA |
Y | 207YP0228X | Pediatric Otolaryngology | R-12193 | IA |
NPI | 1295197242 |
---|---|
Provider Name | Richard Dale Hubbell |
First Address | Iowa City, IA 52242-1009 |
Second Address | Boston, MA 02118-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 10/06/2021 |