Provider Demographics
NPI:1114987120
Name:HUFF, MARVIN R (DO)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:R
Last Name:HUFF
Suffix:
Gender:M
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-7300
Mailing Address - Fax:515-358-7341
Practice Address - Street 1:2755 S. GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-2301
Practice Address - Country:US
Practice Address - Phone:515-358-7300
Practice Address - Fax:515-358-7341
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-02861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8588Medicare PIN
IA1114987120Medicaid
IA719260467Medicare PIN
IAF63042Medicare UPIN
IA98640Medicaid
IA080190760Medicare PIN