Healthcare Provider Details

I. General information

NPI: 1093230955
Provider Name (Legal Business Name): RICHARD E HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 N 28TH WEST AVE
TULSA OK
74127-6139
US

IV. Provider business mailing address

7812 E 96TH PL APT 6107
TULSA OK
74133-6940
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-0197
  • Fax:
Mailing address:
  • Phone: 719-963-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: