Provider Demographics
NPI:1821085457
Name:HUFFMAN, MARK DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1217
Mailing Address - Country:US
Mailing Address - Phone:606-877-1877
Mailing Address - Fax:606-878-9543
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1217
Practice Address - Country:US
Practice Address - Phone:606-877-1877
Practice Address - Fax:606-878-9543
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29931207W00000X
TN39585207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000222015OtherBC
KY64299316Medicaid
KY000000049868OtherANTHEM
TN4032919OtherBC TENN GROUP
KY1536003Medicare PIN
TN3330269Medicare PIN
KYCN6397Medicare PIN
KY180030040Medicare PIN
KY8454Medicare PIN
TN3730063Medicare PIN
000000222015OtherBC
KY000000049868OtherANTHEM