Provider Demographics
NPI:1528003852
Name:HUXFORD, JEFFREY GLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GLEN
Last Name:HUXFORD
Suffix:
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:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0020
Mailing Address - Country:US
Mailing Address - Phone:219-987-3581
Mailing Address - Fax:219-987-7137
Practice Address - Street 1:520 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9108
Practice Address - Country:US
Practice Address - Phone:219-987-3581
Practice Address - Fax:219-987-7137
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061998A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200489280Medicaid
IN390380GOtherMEDICARE ID-TYPE UNSPECIFIED
INI54219Medicare UPIN