Provider Demographics
NPI:1982224325
Name:HUETH, SHON PATRICK (SSA)
Entity Type:Individual
Prefix:MR
First Name:SHON
Middle Name:PATRICK
Last Name:HUETH
Suffix:
Gender:M
Credentials:SSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6796 IVY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7355
Mailing Address - Country:US
Mailing Address - Phone:406-781-3079
Mailing Address - Fax:
Practice Address - Street 1:6796 IVY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7355
Practice Address - Country:US
Practice Address - Phone:406-781-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-365246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant