Healthcare Provider Details

I. General information

NPI: 1003109331
Provider Name (Legal Business Name): MATTHEW LAMAR HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S 800 W
BRIGHAM CITY UT
84302-2400
US

IV. Provider business mailing address

PO BOX 526
BRIGHAM CITY UT
84302-0526
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-8548
  • Fax: 435-538-5066
Mailing address:
  • Phone: 435-538-5061
  • Fax: 435-538-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: