Healthcare Provider Details

I. General information

NPI: 1932196052
Provider Name (Legal Business Name): KEVIN D. HUFFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 N PINE MEADOW DR
DEBARY FL
32713-2306
US

IV. Provider business mailing address

PO BOX 1267
NEW SMYRNA BEACH FL
32170-1267
US

V. Phone/Fax

Practice location:
  • Phone: 866-402-4250
  • Fax:
Mailing address:
  • Phone: 386-402-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 9066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: