Healthcare Provider Details

I. General information

NPI: 1881071595
Provider Name (Legal Business Name): SEAN MAXWELL HUFFORD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 03/12/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER USS TUSCON SSN 770
FPO AP
96674-2397
US

IV. Provider business mailing address

764 CLEARBROOK AVE
SCHERTZ TX
78108-3436
US

V. Phone/Fax

Practice location:
  • Phone: 909-262-4582
  • Fax:
Mailing address:
  • Phone: 909-262-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: