Healthcare Provider Details

I. General information

NPI: 1215602602
Provider Name (Legal Business Name): FRANK HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MARION AVE
FAIRMONT WV
26554-2362
US

IV. Provider business mailing address

1107 MARION AVE
FAIRMONT WV
26554-2362
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-2119
  • Fax:
Mailing address:
  • Phone: 304-431-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: