Grover L Hubbard Jr., LMT
Individual provider Active NPI Specialist · Sweet Home, OR
NPI 1003228016 · NPPES record last updated May 24, 2014
Key facts
- NPI
- 1003228016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 20473 (OR)
- Practice address
- 1262 Main St
Sweet Home, OR 97386-1608 - Phone
- (541) 913-9501
- Fax
- (541) 367-8093
- NPI assigned
- May 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20473 | OR | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 20473 | OR | Yes |
Addresses
Primary practice location
1262 Main St
Sweet Home, OR 97386-1608
Mailing address
1262 Main St
Sweet Home, OR 97386-1608
Phone (541) 913-9501
Other providers in Sweet Home, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.