Active NPI
Gerod Undron Hubbard Jr., LAC, ATC
- Athletic Trainer
- Durant, OK
National Provider Identifier
1609381961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 965
- Practice address
- 425 W University Blvd
Durant, OK 74701-3347 - Phone
- (580) 745-3214
- NPI assigned
- Dec 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 965 | OK | Primary |
Addresses
Primary practice location
425 W University Blvd
Durant, OK 74701-3347
Mailing address
4791 County Road 2105
Hooks, TX 75561-7562
Phone (903) 278-5594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 965 | OK | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512691200000",
"number": "1609381961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4791 COUNTY ROAD 2105",
"city": "HOOKS",
"state": "TX",
"postal_code": "755617562",
"telephone_number": "903-278-5594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 W UNIVERSITY BLVD",
"city": "DURANT",
"state": "OK",
"postal_code": "747013347",
"telephone_number": "580-745-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBARD",
"first_name": "GEROD",
"middle_name": "UNDRON",
"name_suffix": "Jr.",
"credential": "LAC, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-08",
"last_updated": "2017-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OK",
"license": "965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durant, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.