Healthcare Provider Details

I. General information

NPI: 1003884545
Provider Name (Legal Business Name): TIMOTHY J HUDDLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

IV. Provider business mailing address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-2099
  • Fax: 607-535-4433
Mailing address:
  • Phone: 607-535-2099
  • Fax: 607-535-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number146425-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: