Organization
RONALD C. HUBBARD SR., M.D. APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA D TIDWELL (OFFICE MANAGER)
(318) 340-9600
Entity
Organization
Contact information
Practice address
3510 MAGNOLIA CV STE 180, MONROE, LA 71203-2370
(318) 340-9600
(318) 340-9675
Mailing address
3510 MAGNOLIA CV STE 180, MONROE, LA 71203-2370
(318) 340-9600
(318) 340-9675
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
018486
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1377058
—
LA
01
—
54549
MEDICARE
LA
Enumeration date
08/20/2008
Last updated
08/20/2008
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