=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114314077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LEE HUBBARD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2015
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 649
-----------------------------------------------------
City | FORT DEFIANCE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86504-0649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-253-5817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 649
-----------------------------------------------------
City | FORT DEFIANCE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86504-0649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-729-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number | 81726
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number | MD482293
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------