Provider Demographics
NPI:1407024250
Name:HUBER, BRYAN TRAVIS
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:TRAVIS
Last Name:HUBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1731
Mailing Address - Country:US
Mailing Address - Phone:859-621-7926
Mailing Address - Fax:
Practice Address - Street 1:113 CARLTON DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1731
Practice Address - Country:US
Practice Address - Phone:859-621-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other