Provider Demographics
NPI:1023633716
Name:HUBER, STEFAN REID (DO)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:REID
Last Name:HUBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9111 JORDAN LANE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-253-2855
Mailing Address - Fax:254-294-8413
Practice Address - Street 1:9111 JORDAN LANE
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-253-2855
Practice Address - Fax:254-294-8413
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10070623207Q00000X
TXT2630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine