Provider Demographics
NPI:1316949001
Name:HUBBLE, MATTHEW TODD
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TODD
Last Name:HUBBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6862 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2424
Mailing Address - Country:US
Mailing Address - Phone:515-327-1377
Mailing Address - Fax:
Practice Address - Street 1:1725 JORDAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5876
Practice Address - Country:US
Practice Address - Phone:515-226-8921
Practice Address - Fax:515-221-9355
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18763183500000X
MO2004020353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist