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General NPI Number Information
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NPI Number | 1861439499
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Entity Type | Individual
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Provider Name | MARK EDWARD HUBNER MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR 88MDG/SGOHE
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City | WRIGHT PATTERSON AFB
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State | OH
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Zip | 45433-5546
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Country | US
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Telephone | 937-257-1942
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Fax |
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Provider Business Mailing Address
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Address Line | 75 HAWTHORN GLEN TRL
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City | BEAVERCREEK
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State | OH
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Zip | 45440-3547
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Country | US
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Telephone | 937-427-0966
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 40822-020
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License Number State | WI
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