Provider Demographics
NPI:1245295534
Name:HUBBELL, CARL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:EDWARD
Last Name:HUBBELL
Suffix:
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 1:787 E FM 1187
Mailing Address - Street 2:SUITE B
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:817-293-6988
Mailing Address - Fax:817-568-2550
Practice Address - Street 1:787 E FM 1187
Practice Address - Street 2:SUITE B
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036
Practice Address - Country:US
Practice Address - Phone:817-293-6988
Practice Address - Fax:817-568-2550
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1662208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033357701Medicaid
TX00FK13Medicare ID - Type Unspecified
TX033357701Medicaid
B23612Medicare UPIN