Basic Information
| Provider Information | |||||||||
| NPI: | 1457323453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | WINSOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 SERGEANT PRENTISS DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391204792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014429654 | ||||||||
| FaxNumber: | 6014429618 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543994645 | ||||||||
| FaxNumber: | 8558552792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9500291 | NC | N | Other Service Providers | Specialist | 207Q00000X | 9500291 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 890176U | 05 | NC | MEDICAID |