Healthcare Provider Details

I. General information

NPI: 1144283516
Provider Name (Legal Business Name): DENNIS L. HUFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 PROVIDENCE RD SUITE 301
VIRGINIA BEACH VA
23464-4122
US

IV. Provider business mailing address

5320 PROVIDENCE RD SUITE 301
VIRGINIA BEACH VA
23464-4122
US

V. Phone/Fax

Practice location:
  • Phone: 757-413-7600
  • Fax: 757-507-9051
Mailing address:
  • Phone: 757-413-7600
  • Fax: 757-507-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101238801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: