Provider Demographics
NPI:1447262639
Name:LUBBOS, HANNA G (MD)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:G
Last Name:LUBBOS
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:PO BOX 780
Mailing Address - Street 2:201 WEST ARKANSAS ST
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-0780
Mailing Address - Country:US
Mailing Address - Phone:337-239-7227
Mailing Address - Fax:337-238-4299
Practice Address - Street 1:201 W ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4752
Practice Address - Country:US
Practice Address - Phone:337-239-7227
Practice Address - Fax:337-238-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11793R207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-1513327OtherTAX ID
LA1687324Medicaid
LA1687324Medicaid
LA5CD07Medicare ID - Type Unspecified