Healthcare Provider Details

I. General information

NPI: 1346538758
Provider Name (Legal Business Name): DUSTIN R HUFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 6TH ST STE 216
LAWRENCE KS
66044-2249
US

IV. Provider business mailing address

1112 W 6TH ST STE 216
LAWRENCE KS
66044-2249
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-1107
  • Fax: 785-841-1173
Mailing address:
  • Phone: 785-841-1107
  • Fax: 785-841-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01476
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number15-01476
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: