Individual
DR. JACK EDWARD HUBBARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., M.D.
Contact information
Practice address
675 E NICOLLET BLVD, SUITE 100, BURNSVILLE, MN 55337-6749
(952) 435-8516
(763) 302-4336
Mailing address
675 E NICOLLET BLVD, SUITE 100, BURNSVILLE, MN 55337-6749
(952) 435-8516
(763) 302-4336
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
24157
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0265006
PREFERRED ONE
MN
01
—
0506197
MEDICA
MN
01
—
07483HU
BCBS OF MN
MN
01
—
100285C029
UCARE
MN
01
—
130004281
RAILROAD MEDICARE
MN
01
—
22668
AMERICA'S PPO
MN
05
—
30478600
—
WI
05
—
829007500
—
MN
01
—
HP13563
HEALTHPARTNERS
MN
Enumeration date
05/27/2006
Last updated
12/01/2011
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