1487657532 NPI number — DR. ALLISON L HUEBERT M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	HUEBERT
Provider First Name	:	ALLISON
Provider Middle Name	:	L
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	F

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1487657532
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	05/13/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	1800 S DOUGLAS BLVD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	MIDWEST CITY
Provider Business Mailing Address State Name	:	OK
Provider Business Mailing Address Postal Code	:	731306224
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	4057334985
Provider Business Mailing Address Fax Number	:	4057374041

Provider First Line Business Practice Location Address	:	1800 S DOUGLAS BLVD
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	MIDWEST CITY
Provider Business Practice Location Address State Name	:	OK
Provider Business Practice Location Address Postal Code	:	731306224
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	4057334985
Provider Business Practice Location Address Fax Number	:	4057374041
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Title or Position	:
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• Taxonomy code: 207V00000X , with the licence number:  21240 , registered in the state of OK .

• Identifier: BH6720381 . This is a "DEA" identifier , issued by the state of ( OK ) . This identifiers is of the category "".
• Identifier: 38436 . This is a "BNDD" identifier , issued by the state of ( OK ) . This identifiers is of the category "".