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General NPI Number Information
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NPI Number | 1376835777
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Entity Type | Organization
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Legal Business Name | MESA OTOLARYNGOLOGY PC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 1212 BOOKCLIFF AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8162
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Country | US
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Telephone | 970-245-3333
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Fax | 970-243-0414
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Provider Business Mailing Address
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Address Line | 1212 BOOKCLIFF AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8162
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Country | US
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Telephone | 970-245-3333
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Fax | 970-243-0414
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD HUFFAKER
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Credential | D.O.
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Telephone | 970-245-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 20189
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License Number State | CO
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