Healthcare Provider Details

I. General information

NPI: 1336104447
Provider Name (Legal Business Name): ANTHONY HUBBUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 POPLAR LEVEL RD STE. 200-A
LOUISVILLE KY
40217-1395
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-7444
  • Fax: 502-636-7340
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15514
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: