Healthcare Provider Details

I. General information

NPI: 1396906053
Provider Name (Legal Business Name): SHANE LANCE HUFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 N GARFIELD ST SUITE 15
MIDLAND TX
79705-3415
US

IV. Provider business mailing address

PO BOX 4157
MIDLAND TX
79704-4157
US

V. Phone/Fax

Practice location:
  • Phone: 432-699-0306
  • Fax:
Mailing address:
  • Phone: 432-699-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP1767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: