Healthcare Provider Details

I. General information

NPI: 1831743749
Provider Name (Legal Business Name): CARL ALLEN HUFFMAN III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13530 W 116TH TER
OLATHE KS
66062-5768
US

IV. Provider business mailing address

13530 W 116TH TER
OLATHE KS
66062-5768
US

V. Phone/Fax

Practice location:
  • Phone: 913-495-5190
  • Fax: 913-495-5115
Mailing address:
  • Phone: 913-495-5190
  • Fax: 913-495-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: