Organization
JIMMY HUEBERT MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE HUEBERT (OWNER)
(503) 885-8008
Entity
Organization
Contact information
Practice address
6464 SW BORLAND RD STE D2, TUALATIN, OR 97062-8861
(503) 885-8008
(503) 885-8002
Mailing address
6464 SW BORLAND RD STE D2, TUALATIN, OR 97062-8861
(503) 885-8008
(503) 885-8002
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
23362
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131294
INDIVIDUAL MEDICARE PIN#
OR
Enumeration date
02/12/2008
Last updated
07/15/2009
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