Provider Demographics
NPI:1215401716
Name:HUFF, REGINALD EUGENE SR
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:EUGENE
Last Name:HUFF
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 GENERAL MOUTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6817
Mailing Address - Country:US
Mailing Address - Phone:225-910-0628
Mailing Address - Fax:
Practice Address - Street 1:1724 GENERAL MOUTON AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6817
Practice Address - Country:US
Practice Address - Phone:225-910-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver