Healthcare Provider Details

I. General information

NPI: 1013987510
Provider Name (Legal Business Name): LARA HUFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 E REED ST
HAYTI MO
63851-1243
US

IV. Provider business mailing address

907 E REED ST
HAYTI MO
63851-1242
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-1372
  • Fax: 573-359-3608
Mailing address:
  • Phone: 573-359-3660
  • Fax: 573-359-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2012032360
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: