Healthcare Provider Details

I. General information

NPI: 1104853936
Provider Name (Legal Business Name): LAWRENCE JEFFREY HUBACEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110A AIRPORT RD S STE A
PEARL MS
39208-6698
US

IV. Provider business mailing address

510 PINE HILL PL
FLOWOOD MS
39232-8994
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-2887
  • Fax: 855-866-6287
Mailing address:
  • Phone: 769-798-2921
  • Fax: 855-866-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13184
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number13184
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number13184
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: