Provider Demographics
NPI:1316923758
Name:HUBER, STEPHEN CRANE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CRANE
Last Name:HUBER
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 1:1365 MILLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1957
Mailing Address - Country:US
Mailing Address - Phone:610-779-6613
Mailing Address - Fax:
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-1064
Practice Address - Fax:706-571-1986
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0251772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30BDLSNMedicare ID - Type Unspecified
A45565Medicare UPIN