Provider Demographics
NPI:1164507570
Name:JOHN D. HUFFMAN, MD, PC
Entity Type:Organization
Organization Name:JOHN D. HUFFMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-722-8868
Mailing Address - Street 1:266 S CLEVELAND ST
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3520
Mailing Address - Country:US
Mailing Address - Phone:901-722-8868
Mailing Address - Fax:901-722-8867
Practice Address - Street 1:266 S CLEVELAND ST
Practice Address - Street 2:SUITE #104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3520
Practice Address - Country:US
Practice Address - Phone:901-722-8868
Practice Address - Fax:901-722-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN006795208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02121Medicare UPIN