Provider Demographics
NPI:1104001734
Name:HUXLEY, ANGIE K (DO)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:K
Last Name:HUXLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12228
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-2228
Mailing Address - Country:US
Mailing Address - Phone:623-972-1840
Mailing Address - Fax:623-972-1855
Practice Address - Street 1:10222 W COGGINS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3407
Practice Address - Country:US
Practice Address - Phone:623-972-1840
Practice Address - Fax:623-972-1855
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4547207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ137364Medicare PIN
AZZ137364Medicare PIN