Provider Demographics
NPI:1942226162
Name:HUDDLESTON, CHARLES BUFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BUFORD
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1465 SOUTH GRAND BLVD.
Mailing Address - Street 2:SUITE 5730 CARDINAL GLENNON HOSP.
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1095
Mailing Address - Country:US
Mailing Address - Phone:314-268-4183
Mailing Address - Fax:314-577-5313
Practice Address - Street 1:1465 SOUTH GRAND BLVD.
Practice Address - Street 2:SUITE 5730 CARDINAL GLENNON HOSP.
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1095
Practice Address - Country:US
Practice Address - Phone:314-268-4183
Practice Address - Fax:314-577-5313
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-04-24
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Provider Licenses
StateLicense IDTaxonomies
MOR7N52208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202874004Medicaid
020020412Medicare PIN
E16905Medicare UPIN
E16905Medicare UPIN