Healthcare Provider Details

I. General information

NPI: 1376544254
Provider Name (Legal Business Name): DAVID B HUEBNER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 CORPORATE CENTER CT SE STE A
LACEY WA
98503-5952
US

IV. Provider business mailing address

1610 BISHOP RD SW STE 101
TUMWATER WA
98512-7303
US

V. Phone/Fax

Practice location:
  • Phone: 360-764-8293
  • Fax: 360-706-2560
Mailing address:
  • Phone: 360-338-0004
  • Fax: 360-515-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO60211761
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number87
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: