Provider Demographics
NPI:1689671471
Name:HUBBARD, KATHRYN R (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31101 AXIS RUN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4266
Mailing Address - Country:US
Mailing Address - Phone:830-755-8578
Mailing Address - Fax:
Practice Address - Street 1:113 FALLS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2956
Practice Address - Country:US
Practice Address - Phone:830-248-1222
Practice Address - Fax:830-248-1333
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC51725Medicare UPIN