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General NPI Number Information
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NPI Number | 1740437839
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Entity Type | Organization
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Legal Business Name | RONALD C. HUBBARD SR., M.D. APMC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 3510 MAGNOLIA CV STE 180
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City | MONROE
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State | LA
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Zip | 71203-2370
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Country | US
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Telephone | 318-340-9600
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Fax | 318-340-9675
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Provider Business Mailing Address
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Address Line | 3510 MAGNOLIA CV STE 180
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City | MONROE
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State | LA
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Zip | 71203-2370
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Country | US
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Telephone | 318-340-9600
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Fax | 318-340-9675
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REBECCA D TIDWELL
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Credential |
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Telephone | 318-340-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 018486
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License Number State | LA
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