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NPI Code Detail

MEDICARE: DR. JOY L HUDDLESTON M.D.

MEDICARE: DR. JOY L HUDDLESTON 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
12085R0202XDiagnostic Radiology PhysicianME88689MS
22085R0202XDiagnostic Radiology PhysicianME88689FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265432215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOY L HUDDLESTON M.D.
Provider Business Mailing Address
First Line : PO BOX 2400
Second Line :
City : MELBOURNE
State : FL
Zip : 32902-2400
Country : US
Telephone Number : 321-434-4600
Fax Number : 321-259-0635
Provider Business Practice Location Address
First Line : 1350 S HICKORY ST
Second Line : HOLMES REGIONAL MEDICAL CENTER/RADIOLOGY
City : MELBOURNE
State : FL
Zip : 32901-3224
Country : US
Telephone Number : 321-434-7313
Fax Number : 321-434-7238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 08/05/2013

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