Healthcare Provider Details

I. General information

NPI: 1447227400
Provider Name (Legal Business Name): STEPHEN KEITH HUBBARD IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD NAVAL HOSPITAL BREMERTON
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

267 FERN MEADOWS LOOP SE
PORT ORCHARD WA
98366-3914
US

V. Phone/Fax

Practice location:
  • Phone: 360-476-6902
  • Fax: 360-476-2480
Mailing address:
  • Phone: 360-769-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: