Provider Demographics
NPI:1740241660
Name:HUDDLE, DANIEL C (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:HUDDLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:970-490-4347
Practice Address - Street 1:1725 E BOULDER ST STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-365-7300
Practice Address - Fax:719-365-7301
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-365472085R0202X
HIDOS15812085R0202X
NE6722085R0202X
CO392312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1740241660Medicaid
OK200025570AMedicaid
WY109589700Medicaid
CO03679721Medicaid
NM2822768Medicaid
MI104719840Medicaid
TX171617701Medicaid
NE84059792913Medicaid
NE10025709000Medicaid
SD1740241660Medicaid
KS100414050BMedicaid
CA1740241660Medicaid
COC500888Medicare PIN
COC500878Medicare PIN
COF89053Medicare UPIN
WY109589700Medicaid
KS111257017Medicare PIN
COC500868Medicare PIN
CO03679721Medicaid
COC803274Medicare PIN
TX171617701Medicaid
NE84059792913Medicaid
NM2822768Medicaid
OK200025570AMedicaid
COP00029139Medicare PIN
NENA1214036Medicare PIN
COCO304764Medicare PIN