Provider Demographics
NPI:1881689032
Name:HUFFMAN, LEROY J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:J
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 1:7430 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2903
Mailing Address - Country:US
Mailing Address - Phone:839-200-7810
Mailing Address - Fax:803-891-7085
Practice Address - Street 1:1301 TAYLOR ST STE 5K
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2952
Practice Address - Country:US
Practice Address - Phone:839-200-7805
Practice Address - Fax:803-891-7085
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC087300Medicaid
SC930073233OtherRAILROAD MEDICARE
SC930073233OtherRAILROAD MEDICARE
SCG604335038Medicare PIN
SCG60433Medicare UPIN