Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101267841 | VA |
N | 2081S0010X | Sports Medicine | 0101267841 | VA |
N | 213ES0000X | Sports Medicine | 0101267841 | VA |
NPI | 1184030009 |
---|---|
Provider Name | Ryan Hubbard |
First Address | Arlington, VA 22206-2998 |
Second Address | Arlington, VA 22206-2998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2014 |
Last Update Date | 02/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101267841 | VA LICENSE (01) | VA |