Basic Information
| Provider Information | |||||||||
| NPI: | 1487979464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 ENTERPRISE ROAD | ||||||||
| Address2: | MIRACLE-EAR | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187362284 | ||||||||
| FaxNumber: | 5187362285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1302 SE EVERETT MALL WAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982082831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254238616 | ||||||||
| FaxNumber: | 4253533946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2010 | ||||||||
| LastUpdateDate: | 04/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA60072872 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.