Provider Demographics
NPI:1063614584
Name:HUBERT, MARK GREGORY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:HUBERT
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 1:800 PEAKWOOD DR STE 5D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:832-353-2498
Mailing Address - Fax:832-353-2499
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:STE 5D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2900
Practice Address - Country:US
Practice Address - Phone:832-353-2498
Practice Address - Fax:832-353-2499
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025675207X00000X
PAMD436380207X00000X
TXN9877207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977021OtherTRICARE
TX284517402Medicaid
TX284517401Medicaid
TX284517403Medicaid
TX284517401Medicaid
MO152360313Medicare PIN
TX752616977021OtherTRICARE
TXP00986445Medicare PIN
TX284517402Medicaid