MEDICARE: DAVID B HUANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	109950	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	128576	OTHER		BC/BS

General Provider Information

NPI Number	:	1063418879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B HUANG M.D.

Provider Business Mailing Address
First Line	:	985 EXECUTIVE DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3496
Country	:	US
Telephone Number	:	573-348-4863
Fax Number	:	573-348-4863

Provider Business Practice Location Address
First Line	:	985 EXECUTIVE DRIVE
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065
Country	:	US
Telephone Number	:	573-348-4863
Fax Number	:	573-348-4863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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Directions to “ DAVID B HUANG M.D.” Practice Location

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