Provider Demographics
NPI:1124119854
Name:HUBBARD, BRADLEY A (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 8080 PO BOX 650002
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0002
Mailing Address - Country:US
Mailing Address - Phone:214-370-4813
Mailing Address - Fax:469-375-3844
Practice Address - Street 1:9101 N CENTRAL EXPY STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5956
Practice Address - Country:US
Practice Address - Phone:214-370-4813
Practice Address - Fax:469-375-3844
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN89312086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery