Healthcare Provider Details

I. General information

NPI: 1992128573
Provider Name (Legal Business Name): ROGER TRUBEY DR. PH, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 02/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BROADWAY ST
HOT SPRINGS AR
71901-5450
US

IV. Provider business mailing address

455 BROADWAY ST
HOT SPRINGS AR
71901-5450
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-1248
  • Fax:
Mailing address:
  • Phone: 501-624-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: