Provider Demographics
NPI:1376576033
Name:ROGER L HUF MD A MEDICAL CORP
Entity Type:Organization
Organization Name:ROGER L HUF MD A MEDICAL CORP
Other - Org Name:ROGER LLOYD HUF
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-258-7300
Mailing Address - Street 1:5855 GREEN VALLEY CIRCLE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230
Mailing Address - Country:US
Mailing Address - Phone:310-258-7300
Mailing Address - Fax:310-258-7302
Practice Address - Street 1:5855 GREEN VALLEY CIRCLE SUITE 200
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:310-258-7300
Practice Address - Fax:310-258-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADN2287OtherRAILROAD MEDICARE
CAAH7659367OtherDEA
CAW21607Medicare PIN
CACX592AMedicare PIN
CADN2287OtherRAILROAD MEDICARE