Healthcare Provider Details

I. General information

NPI: 1043574650
Provider Name (Legal Business Name): MICHAEL DAVID HUBBARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

2073 APPALOOSA TRL
HIGH RIDGE MO
63049-1768
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-9491
  • Fax:
Mailing address:
  • Phone: 660-353-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number05-50963
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2012017895
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: