Basic Information
| Provider Information | |||||||||
| NPI: | 1215986419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBLER | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUBLER | ||||||||
| OtherFirstName: | DAVID | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053286585 | ||||||||
| FaxNumber: | 6053286512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 DIAGONAL RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561871008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073723800 | ||||||||
| FaxNumber: | 5073723806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 57014 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 37777 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD60576013 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD-15086 | HI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 23052 | WV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208000000X | 12506 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207X00000X | 13963 | NH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 20009017804 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 43010914168 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD2011-0762 | NM | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 23657 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 101244568 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD186494 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 01067789A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | E0992 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000647372 | 01 | IN | ANTHEM | OTHER | 200019500A | 05 | OK | MEDICAID | 200974490 | 05 | IN | MEDICAID |