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General NPI Number Information
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NPI Number | 1104853936
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Entity Type | Individual
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Provider Name | LAWRENCE JEFFREY HUBACEK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 110A AIRPORT RD S STE A
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City | PEARL
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State | MS
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Zip | 39208-6698
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Country | US
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Telephone | 601-936-2887
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Fax | 855-866-6287
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Provider Business Mailing Address
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Address Line | 510 PINE HILL PL
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City | FLOWOOD
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State | MS
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Zip | 39232-8994
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Country | US
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Telephone | 769-798-2921
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Fax | 855-866-6287
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 13184
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 13184
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 13184
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License Number State | MS
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