Healthcare Provider Details

I. General information

NPI: 1457085995
Provider Name (Legal Business Name): MATTHEW HUBBARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 A ST
GREELEY CO
80631-2021
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-313-0400
  • Fax:
Mailing address:
  • Phone: 970-391-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0008719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: