Healthcare Provider Details

I. General information

NPI: 1275673949
Provider Name (Legal Business Name): BRETT J HUBBARD N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 SE JOHNSON RD SUITE 110
MILWAUKIE OR
97267-2316
US

IV. Provider business mailing address

11140 SW LANCASTER RD
PORTLAND OR
97219-7631
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-7272
  • Fax: 503-786-7799
Mailing address:
  • Phone: 503-238-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1006
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: