MEDICARE: DR. JACQUELINE 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	207R00000X	Internal Medicine Physician	E5791	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8BM541	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1972588333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE HUBBARD M.D.

Provider Business Mailing Address
First Line	:	9101 LBJ FWY
Second Line	:	STE 710
City	:	DALLAS
State	:	TX
Zip	:	75243-2057
Country	:	US
Telephone Number	:	972-792-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	STE. 905
City	:	DALLAS
State	:	TX
Zip	:	75231-4405
Country	:	US
Telephone Number	:	214-378-7605
Fax Number	:

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	02/13/2009

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