Provider Demographics
NPI:1306823828
Name:HUEY, WAYNE A (DO)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:A
Last Name:HUEY
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:BOX 580
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089
Mailing Address - Country:US
Mailing Address - Phone:405-381-2301
Mailing Address - Fax:405-381-3592
Practice Address - Street 1:6 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-9171
Practice Address - Country:US
Practice Address - Phone:405-381-2301
Practice Address - Fax:405-381-3592
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09719Medicare UPIN