Provider Demographics
NPI:1215904602
Name:HUBER, AMY A (MD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:A
Last Name:HUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6727
Mailing Address - Country:US
Mailing Address - Phone:901-726-6655
Mailing Address - Fax:901-726-9056
Practice Address - Street 1:1455 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6727
Practice Address - Country:US
Practice Address - Phone:901-726-6655
Practice Address - Fax:901-726-9056
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35480207NS0135X, 207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88211Medicare UPIN
3887547Medicare ID - Type Unspecified