Healthcare Provider Details

I. General information

NPI: 1225238835
Provider Name (Legal Business Name): RYAN THOMAS HUBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY # 120
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

700 LAWRENCE EXPY # 120
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-5633
  • Fax:
Mailing address:
  • Phone: 408-851-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA147548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: