Healthcare Provider Details

I. General information

NPI: 1356902365
Provider Name (Legal Business Name): JENNIFER LEE HUFFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # MC404
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR # MC404
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-2000
  • Fax: 573-884-4611
Mailing address:
  • Phone: 573-884-2000
  • Fax: 573-884-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2019021887
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: