Healthcare Provider Details

I. General information

NPI: 1508442989
Provider Name (Legal Business Name): GARY HUFFMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1708
US

IV. Provider business mailing address

2998 US HIGHWAY 62 SW
WASHINGTON COURT HOUSE OH
43160-8851
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-8131
  • Fax:
Mailing address:
  • Phone: 740-572-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.322149
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: