MEDICARE: DR. PATRICK ANDREW HUDDLESTON 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
1	208800000X	Urology Physician	S9708	TX

General Provider Information

NPI Number	:	1477908291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK ANDREW HUDDLESTON MD

Provider Business Mailing Address
First Line	:	5001 S COOPER ST STE 201
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-5993
Country	:	US
Telephone Number	:	866-367-8768
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 FOUNDERS WAY STE 205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4955
Country	:	US
Telephone Number	:	866-367-8768
Fax Number	:

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

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	06/07/2022

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