Provider Demographics
NPI:1548297641
Name:HUBBARD, RICHARD O (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:HUBBARD
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 1:1824 WESTOVER SQ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3501
Mailing Address - Country:US
Mailing Address - Phone:817-996-1903
Mailing Address - Fax:
Practice Address - Street 1:1824 WESTOVER SQ
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3501
Practice Address - Country:US
Practice Address - Phone:817-996-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4870207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120112106Medicaid
TX8H9673OtherBLUE CROSS BLUE SHIELD
TX120112106Medicaid
TX8H9673OtherBLUE CROSS BLUE SHIELD