Provider Demographics
NPI:1063614584
Name:HUBERT, MARK GREGORY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:HUBERT
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 1:2020 PALOMINO LN STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4892
Mailing Address - Country:US
Mailing Address - Phone:702-474-7200
Mailing Address - Fax:702-474-0009
Practice Address - Street 1:2020 PALOMINO LN STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4892
Practice Address - Country:US
Practice Address - Phone:702-474-7200
Practice Address - Fax:702-474-0009
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27531207X00000X, 207XX0801X
TXN9877207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977021OtherTRICARE
TX284517402Medicaid
TX284517401Medicaid
TX284517403Medicaid
TX284517401Medicaid
MO152360313Medicare PIN
TX752616977021OtherTRICARE
TXP00986445Medicare PIN
TX284517402Medicaid