Healthcare Provider Details

I. General information

NPI: 1457323453
Provider Name (Legal Business Name): KARL WINSOR HUBBARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

46 SERGEANT PRENTISS DR SUITE 103
NATCHEZ MS
39120-4792
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4645
  • Fax: 855-855-2792
Mailing address:
  • Phone: 601-442-9654
  • Fax: 601-442-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9500291
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: