Provider Demographics
NPI:1093840688
Name:HUCKABY, GRADY B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:B
Last Name:HUCKABY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4050 BARRANCA PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7706
Mailing Address - Country:US
Mailing Address - Phone:949-559-5601
Mailing Address - Fax:949-559-7115
Practice Address - Street 1:4050 BARRANCA PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7706
Practice Address - Country:US
Practice Address - Phone:949-559-5601
Practice Address - Fax:949-559-7115
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-11-30
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Provider Licenses
StateLicense IDTaxonomies
CAA314952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine