Provider Demographics
NPI:1346462306
Name:HUFFAKER, SCOTT KERMIT (DO,)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KERMIT
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-635-4023
Mailing Address - Fax:989-635-5297
Practice Address - Street 1:2750 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1100
Practice Address - Country:US
Practice Address - Phone:989-635-4023
Practice Address - Fax:989-635-5297
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B50203OtherBCBSM
MI0B51442OtherBCBS OF MI