Healthcare Provider Details

I. General information

NPI: 1053310086
Provider Name (Legal Business Name): ALLAN D. HUFFMAN M.D.07/05
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HOSPITAL WAY
BREWSTER WA
98812-0019
US

IV. Provider business mailing address

PO BOX 577
BREWSTER WA
98812-0577
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-2517
  • Fax: 509-689-2086
Mailing address:
  • Phone: 509-689-2517
  • Fax: 509-689-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60569749
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: