Provider Demographics
NPI:1265429559
Name:HUDDLE, JOHN P (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HUDDLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 BALDWIN CT
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9582
Mailing Address - Country:US
Mailing Address - Phone:419-281-4020
Mailing Address - Fax:419-281-8767
Practice Address - Street 1:1109 EASTERN AVE
Practice Address - Street 2:BOX 755
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4022
Practice Address - Country:US
Practice Address - Phone:419-281-4020
Practice Address - Fax:419-281-8767
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340022272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122727Medicaid
OH0771316Medicare PIN
OH0122727Medicaid