Provider Demographics
NPI:1447227400
Name:HUBBARD, STEPHEN KEITH (IDC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 FERN MEADOWS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3914
Mailing Address - Country:US
Mailing Address - Phone:360-769-8956
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-476-6902
Practice Address - Fax:360-476-2480
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman