Healthcare Provider Details

I. General information

NPI: 1881689032
Provider Name (Legal Business Name): LEROY J. HUFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TAYLOR ST STE 5K
COLUMBIA SC
29201-2952
US

IV. Provider business mailing address

7430 COLLEGE ST
IRMO SC
29063-2903
US

V. Phone/Fax

Practice location:
  • Phone: 839-200-7805
  • Fax: 803-891-7085
Mailing address:
  • Phone: 839-200-7810
  • Fax: 803-891-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8730
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: