Healthcare Provider Details

I. General information

NPI: 1841498300
Provider Name (Legal Business Name): RICHARD K HUFFAKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 SW UNION AVE
GRANTS PASS OR
97527-5543
US

IV. Provider business mailing address

2825 E BARNETT RD MSS
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 541-507-2150
  • Fax: 541-507-2151
Mailing address:
  • Phone: 541-789-4281
  • Fax: 541-789-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberDO157588
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: