Provider Demographics
NPI:1245272145
Name:HUBER, PHILIP J JR (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:HUBER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6833
Mailing Address - Country:US
Mailing Address - Phone:972-566-6115
Mailing Address - Fax:214-358-0186
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:STE 306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:214-345-8060
Practice Address - Fax:214-345-8229
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3311208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105004905Medicaid
TX105004906Medicaid
TX105004904Medicaid
TX105004903Medicaid
TX105004903Medicaid
TX8L2728Medicare PIN
8C9853Medicare ID - Type Unspecified
C17153Medicare UPIN
TX8L2729Medicare PIN