MEDICARE: JAMES G HUBBARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4525A	WY
2	2085R0202X	Diagnostic Radiology Physician	29468	CO
3	2085R0202X	Diagnostic Radiology Physician	21266	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	306014	OTHER	WY	BCBS WYOMING
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326083361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES G HUBBARD M.D.

Provider Business Mailing Address
First Line	:	2003 BLUEGRASS CIR
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-7329
Country	:	US
Telephone Number	:	307-634-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E 20TH ST
Second Line	:	SUITE 110
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3859
Country	:	US
Telephone Number	:	307-634-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/18/2015

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