Healthcare Provider Details

I. General information

NPI: 1609845809
Provider Name (Legal Business Name): CHARLES JASON HUBBARD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 32ND ST STE 101
AUSTIN TX
78705-2707
US

IV. Provider business mailing address

1015 E. 32ND ST. STE 101
AUSTIN TX
78705
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-6341
  • Fax: 512-244-1013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1625
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: