Provider Demographics
NPI:1306279724
Name:HUBBARD, DUSTIN RANDALL (DPM)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RANDALL
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KELLUM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4189
Mailing Address - Country:US
Mailing Address - Phone:907-451-9202
Mailing Address - Fax:
Practice Address - Street 1:1405 KELLUM ST STE 200
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4189
Practice Address - Country:US
Practice Address - Phone:907-451-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK119256213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery