Healthcare Provider Details

I. General information

NPI: 1790299030
Provider Name (Legal Business Name): WILLIAM HICKS HUFFMAN JR. B.A., CDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 E SKELLY DR
TULSA OK
74135-6106
US

IV. Provider business mailing address

3505 E 88TH ST
TULSA OK
74137-2602
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-4224
  • Fax:
Mailing address:
  • Phone: 918-557-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: