Provider Demographics
NPI:1992128573
Name:TRUBEY, ROGER (DR PH, MPH)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:TRUBEY
Suffix:
Gender:M
Credentials:DR PH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5450
Mailing Address - Country:US
Mailing Address - Phone:501-624-1248
Mailing Address - Fax:
Practice Address - Street 1:455 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5450
Practice Address - Country:US
Practice Address - Phone:501-624-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND439133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist