1376544254 NPI number — DAVID B HUEBNER DPM

Table of content: DAVID B HUEBNER DPM (NPI 1376544254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376544254 NPI number — DAVID B HUEBNER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUEBNER
Provider First Name:
DAVID
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1376544254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 BISHOP RD SW STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98512-7303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-338-0004
Provider Business Mailing Address Fax Number:
360-515-0744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5210 CORPORATE CENTER CT SE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98503-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-764-8293
Provider Business Practice Location Address Fax Number:
360-706-2560
Provider Enumeration Date:
08/02/2005

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: 213ES0103X , with the licence number:  PO60211761 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 87 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0390780 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".