Provider Demographics
NPI:1669443131
Name:HUFFMAN, RICHARD L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15216 KEVIN LANE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734
Mailing Address - Country:US
Mailing Address - Phone:573-578-7775
Mailing Address - Fax:
Practice Address - Street 1:4544 S LAMAR BLVD
Practice Address - Street 2:STE 700
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-834-4141
Practice Address - Fax:512-834-4142
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX887402163W00000X
TXAP125181367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345038901Medicaid
TX345038901Medicaid
MOP00860854OtherMEDICARE RAILROAD CARRIER
MO1669443131Medicaid
MOP01256177OtherRR MCR