Provider Demographics
NPI:1528017472
Name:HUCK, MINOR L (MD)
Entity Type:Individual
Prefix:
First Name:MINOR
Middle Name:L
Last Name:HUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 HIGHLANDER BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4330
Mailing Address - Country:US
Mailing Address - Phone:817-516-8811
Mailing Address - Fax:817-516-8444
Practice Address - Street 1:700 HIGHLANDER BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4330
Practice Address - Country:US
Practice Address - Phone:817-516-8811
Practice Address - Fax:817-516-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXC9443207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089924702Medicaid
TX0006EWOtherBLUE CROSS & BLUE SHIELD
TX089924702Medicaid
TXB23619Medicare UPIN