MEDICARE: GEORGE PEYTON HUBBELL MD

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	207V00000X	Obstetrics & Gynecology Physician	R2P55	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00825494	OTHER	MO	RAILROAD MEDICARE-CB9013

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	431560263	OTHER	MO	TRICARE WEST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821086760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE PEYTON HUBBELL MD

Provider Business Mailing Address
First Line	:	1055 OZARK CARE DR
Second Line	:	SUITE B
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3016
Country	:	US
Telephone Number	:	573-348-6101
Fax Number	:	573-348-6324

Provider Business Practice Location Address
First Line	:	1055 OZARK CARE DR
Second Line	:	SUITE B
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3016
Country	:	US
Telephone Number	:	573-348-6101
Fax Number	:	573-348-6324

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/01/2010

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Directions to “ GEORGE PEYTON HUBBELL MD” Practice Location

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