Healthcare Provider Details

I. General information

NPI: 1548421449
Provider Name (Legal Business Name): ANDREW SCOTT HUARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E HARRIS AVE
SAN ANGELO TX
76903-5904
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 325-653-6741
  • Fax: 325-481-2166
Mailing address:
  • Phone: 325-658-1511
  • Fax: 325-481-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number046507
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH1976
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: