Basic Information
| Provider Information | |||||||||
| NPI: | 1700141520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 MEDICAL CIR | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067836455 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY 800 ROSE STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2629 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 2629 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DO0000002629 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04606 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | DO0000002629 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04606 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 2629 | TN | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.