Healthcare Provider Details

I. General information

NPI: 1104261882
Provider Name (Legal Business Name): DAVID ANDREW HUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 AMERICAN WAY RESURRECTION FAMILY MEDICINE RESIDENCY
MEMPHIS TN
38118-8339
US

IV. Provider business mailing address

4095 AMERICAN WAY
MEMPHIS TN
38118-8339
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-9500
  • Fax:
Mailing address:
  • Phone: 901-271-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: