Provider Demographics
NPI:1659489771
Name:HUFSMITH, SANDRA J (MD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:J
Last Name:HUFSMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3923
Mailing Address - Country:US
Mailing Address - Phone:541-754-1415
Mailing Address - Fax:541-754-9848
Practice Address - Street 1:2294 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3923
Practice Address - Country:US
Practice Address - Phone:541-754-1415
Practice Address - Fax:541-754-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13089207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212391OtherHEALTHNET
OR212391OtherCIGNA
OR268375Medicaid
ORE039801OtherPACIFICSOURCE
ORR0000BHQHMOtherMEDICARE ID-PIN
OR90085816OtherPACIFICARE
OR268375Medicaid
ORR0000BHQHMMedicare PIN