Provider Demographics
NPI:1043206774
Name:BABINEAU, HUGH P (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:P
Last Name:BABINEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E LAKE ST
Mailing Address - Street 2:STE 230
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3343
Mailing Address - Country:US
Mailing Address - Phone:903-593-0230
Mailing Address - Fax:903-597-3015
Practice Address - Street 1:1100 E LAKE ST
Practice Address - Street 2:STE 230
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3343
Practice Address - Country:US
Practice Address - Phone:903-593-0230
Practice Address - Fax:903-597-3015
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL 1797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S2030OtherBCBS
TX1486250-01Medicaid
TX00Y577Medicare PIN
H42214Medicare UPIN