1023633716 NPI number — STEFAN REID HUBER DO

Table of content: STEFAN REID HUBER DO (NPI 1023633716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023633716 NPI number — STEFAN REID HUBER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBER
Provider First Name:
STEFAN
Provider Middle Name:
REID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1023633716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9111 JORDAN LANE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WOODWAY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-253-2855
Provider Business Mailing Address Fax Number:
254-294-8413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9111 JORDAN LANE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WOODWAY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-253-2855
Provider Business Practice Location Address Fax Number:
254-294-8413
Provider Enumeration Date:
06/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  BP10070623 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: T2630 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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