Healthcare Provider Details

I. General information

NPI: 1972667632
Provider Name (Legal Business Name): JOANNE IRBY HUNTINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SIXTH STREET UNIT A
CRESTED BUTTE CO
81224
US

IV. Provider business mailing address

PO BOX 1668
CRESTED BUTTE CO
81224-1668
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-7193
  • Fax: 866-245-3787
Mailing address:
  • Phone: 970-349-7193
  • Fax: 866-245-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: