Provider Demographics
NPI:1891743944
Name:HUFF, DANIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:HUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 4205
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4205
Mailing Address - Country:US
Mailing Address - Phone:208-406-3116
Mailing Address - Fax:208-237-3860
Practice Address - Street 1:5245 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4676
Practice Address - Country:US
Practice Address - Phone:208-406-3116
Practice Address - Fax:208-237-3860
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807176900Medicaid
ID807176900Medicaid
IDI32079Medicare UPIN