Provider Demographics
NPI:1659506038
Name:GAUGHT, AMBER MARIE HUFFMAN (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE HUFFMAN
Last Name:GAUGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-788-8797
Practice Address - Fax:919-313-1276
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00355208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2013-00355OtherNC LICENSE