Provider Demographics
NPI:1619037496
Name:HUDDLESTON, JAMES IRVIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:IRVIN
Last Name:HUDDLESTON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:450 BROADWAY ST
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3132
Mailing Address - Country:US
Mailing Address - Phone:650-721-7661
Mailing Address - Fax:650-721-3470
Practice Address - Street 1:450 BROADWAY ST
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3132
Practice Address - Country:US
Practice Address - Phone:650-723-5643
Practice Address - Fax:650-721-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-07-10
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Provider Licenses
StateLicense IDTaxonomies
CAA90915207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI-10317Medicare UPIN