=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194156505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HARRISON HUBBELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2013
-----------------------------------------------------
Last Update Date | 12/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 838 STONEHAVEN DR
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-933-0664
-----------------------------------------------------
Fax | 925-933-0443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 838 STONEHAVEN DRIVE
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-933-0664
-----------------------------------------------------
Fax | 925-933-0443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | AFE19661
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------