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NPI Code Detail

MEDICARE: SAMUEL W HUOT MD

MEDICARE: SAMUEL W HUOT MD
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
1207Q00000XFamily Medicine Physician1195SD

General Provider Information

NPI Number : 1104860683
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL W HUOT MD
Provider Business Mailing Address
First Line : PO BOX 6020
Second Line :
City : RAPID CITY
State : SD
Zip : 57709-6020
Country : US
Telephone Number : 605-721-8354
Fax Number : 605-721-8458
Provider Business Practice Location Address
First Line : 3810 JACKSON BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3246
Country : US
Telephone Number : 605-343-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 02/11/2013

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