Provider Demographics
NPI:1396776761
Name:HUFFMAN, THOMAS LAURENCE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAURENCE
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:11863 STATE HWY 13
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686-0555
Mailing Address - Country:US
Mailing Address - Phone:417-739-1995
Mailing Address - Fax:417-739-1893
Practice Address - Street 1:701 OLD WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:REEDS SPRING
Practice Address - State:MO
Practice Address - Zip Code:65737-8626
Practice Address - Country:US
Practice Address - Phone:417-272-0050
Practice Address - Fax:417-272-9058
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00125467OtherRAILROAD MEDICARE
1662OtherCOX HEALTH SYSTEMS
176608OtherHEALTHLINK
MO200025757Medicaid
27276OtherBCBS
MOD79455Medicare UPIN
MO200025757Medicaid
1662OtherCOX HEALTH SYSTEMS
P00125467OtherRAILROAD MEDICARE
069050098Medicare PIN