Provider Demographics
NPI:1427006279
Name:HUERTA, JOE M (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:M
Last Name:HUERTA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 515
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6152
Mailing Address - Country:US
Mailing Address - Phone:520-296-8500
Mailing Address - Fax:520-733-2389
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 515
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-296-8500
Practice Address - Fax:520-733-2389
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6166207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200600Medicaid
AZZ22713Medicare ID - Type Unspecified
AZ200600Medicaid