Provider Demographics
NPI:1861416190
Name:HUBNER, JOHN E (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:HUBNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2000 S WHEELING AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5646
Mailing Address - Country:US
Mailing Address - Phone:918-742-5533
Mailing Address - Fax:918-743-7293
Practice Address - Street 1:2000 S WHEELING AVE STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5646
Practice Address - Country:US
Practice Address - Phone:918-742-5533
Practice Address - Fax:918-743-7293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110238214OtherRAILROAD MEDICARE
OK100120160AMedicaid
G32239Medicare UPIN