Modera Clinic Gi, PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

MODERA CLINIC GI, PLLC

Practice address

5575 Frisco Square Blvd
220
Frisco, TX 75034-3303

Phone

(469) 920-2302

NPI assigned

Jun 13, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Trevor Huber, DO

Title

President

Phone

(972) 987-0458

Specialties & licenses 1

Addresses

Other names 1

• Modera GI Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1063142115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5575 FRISCO SQUARE BLVD",
            "address_2": "#220",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750343303",
            "telephone_number": "469-920-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 FRISCO SQUARE BLVD",
            "address_2": "220",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750343303",
            "telephone_number": "469-920-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERA CLINIC GI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-13",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-987-0458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modera GI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Modera GI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gastroenterology Physician in Frisco, TX
• Providers in Frisco, TX by specialty
• Gastroenterology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.