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NPI Code Detail

MEDICARE: DR. TRENTON ROSS HUBBARD M.D.

MEDICARE: DR. TRENTON ROSS HUBBARD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician125062383IL
2208000000XPediatrics PhysicianA167536CA
32080C0008XChild Abuse Pediatrics PhysicianA167536CA
42080C0008XChild Abuse Pediatrics Physician73222AZ

General Provider Information

NPI Number : 1487919155
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRENTON ROSS HUBBARD M.D.
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-3124
Fax Number : 559-353-5708
Provider Business Practice Location Address
First Line : 2120 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1455
Country : US
Telephone Number : 602-933-6100
Fax Number : 602-933-2422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2012
Last Update Date : 08/28/2024

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