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Organization
MODERA CLINIC PLLC
Active
Organization
MODERA CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREVOR KYLE HUBER DO (OWNER)
(972) 987-0458
Entity
Organization
Contact information
Practice address
2700 E ELDORADO PKWY STE 104B, LITTLE ELM, TX 75068-5999
(972) 987-0458
(877) 459-3573
Mailing address
2700 E ELDORADO PKWY STE 104B, LITTLE ELM, TX 75068-5999
(972) 987-0458
(877) 459-3573
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
Q7559
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174938831
NPI
—
01
—
1649682857
NPI
—
01
—
B0226719
DPS
—
01
—
Q7559
LICENSE
TX
01
—
Q9244
LICENSE
TX
Enumeration date
08/23/2016
Last updated
03/07/2023
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