Provider Demographics
NPI:1710636543
Name:HUBBARD, RENEE C (DO)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 KING DAVID DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7381
Mailing Address - Country:US
Mailing Address - Phone:608-843-6304
Mailing Address - Fax:
Practice Address - Street 1:72 KING DAVID DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7381
Practice Address - Country:US
Practice Address - Phone:608-843-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine