Healthcare Provider Details

I. General information

NPI: 1891743944
Provider Name (Legal Business Name): DANIEL M HUFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 COUNTRY CLUB DR
POCATELLO ID
83204-4676
US

IV. Provider business mailing address

PO BOX 4205
POCATELLO ID
83205-4205
US

V. Phone/Fax

Practice location:
  • Phone: 208-406-3116
  • Fax: 208-237-3860
Mailing address:
  • Phone: 208-406-3116
  • Fax: 208-237-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM-9249
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: