Provider Demographics
NPI:1669632915
Name:HUDDLESTON, COE EDWIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:COE
Middle Name:EDWIN
Last Name:HUDDLESTON
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Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3000 NEW BERN AVE
Mailing Address - Street 2:HEART CENTER ADMINISTRATION
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-350-7601
Mailing Address - Fax:919-350-1742
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:HEART CENTER ADMINISTRATION
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-7601
Practice Address - Fax:919-350-1742
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant