Provider Demographics
NPI:1154588978
Name:HUBBARD, BENJAMIN C (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:C
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:407 E 2ND AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1428
Mailing Address - Country:US
Mailing Address - Phone:509-534-6820
Mailing Address - Fax:509-534-6821
Practice Address - Street 1:407 E 2ND AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1428
Practice Address - Country:US
Practice Address - Phone:509-534-6820
Practice Address - Fax:509-534-6821
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 600247722083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOL20000103OtherMEDICAL LICENSE