Healthcare Provider Details

I. General information

NPI: 1477811305
Provider Name (Legal Business Name): BROOKE AINSLEY HUFFSMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2012
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

1134 CROSSFIELD DR
KATY TX
77450-3065
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-4100
  • Fax:
Mailing address:
  • Phone: 281-923-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number86529
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number66959
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberQ9641
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number54694
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2021-0468
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: