Provider Demographics
NPI:1487626560
Name:HUFFMON, GEORGE VAN BUREN III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:VAN BUREN
Last Name:HUFFMON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 S. 17TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7594
Mailing Address - Country:US
Mailing Address - Phone:910-763-3333
Mailing Address - Fax:910-763-3336
Practice Address - Street 1:2208 S 17TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7515
Practice Address - Country:US
Practice Address - Phone:910-763-3333
Practice Address - Fax:910-763-3336
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891134VMedicaid
NC1134VOtherBLUE CROSS/BLUE SHIELD
NC104765400OtherUS DEPT OF LABOR ID
NC2253929CMedicare ID - Type UnspecifiedPHYSICIAN'S PERSONAL #
NC104765400OtherUS DEPT OF LABOR ID