Provider Demographics
NPI:1639152028
Name:HUFFORD, DAVID R JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HUFFORD
Suffix:JR
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 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-446-1422
Mailing Address - Fax:704-446-1582
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1422
Practice Address - Fax:704-446-1582
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053021H2080P0214X
OH350530212080P0203X
NC2008-016172080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711635Medicaid
NC1639152028Medicaid
SCN17009Medicaid
NC5910326Medicaid
NCNCA989AMedicare PIN
NC5910326Medicaid
OH0711635Medicaid
SCN17009Medicaid