MEDICARE: DR. JOHN THOMAS HUBER II PH.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	103TC0700X	Clinical Psychologist	PY9095	FL

General Provider Information

NPI Number	:	1518435924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS HUBER II PH.D.

Provider Business Mailing Address
First Line	:	11400 4TH ST N APT 1408
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-2925
Country	:	US
Telephone Number	:	850-525-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 15TH ST BLDG 14401
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5207
Country	:	US
Telephone Number	:	706-791-9191
Fax Number	:

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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