Healthcare Provider Details

I. General information

NPI: 1316388325
Provider Name (Legal Business Name): ANDREW T HUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COFFEE RD STE 200
MODESTO CA
95355
US

IV. Provider business mailing address

1552 COFFEE RD STE 200
MODESTO CA
95355-3122
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7168
  • Fax:
Mailing address:
  • Phone: 209-248-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA134599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: