Provider Demographics
NPI:1700806494
Name:HUDDLE, ROBERT HARRY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HARRY
Last Name:HUDDLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2228
Mailing Address - Country:US
Mailing Address - Phone:607-734-3015
Mailing Address - Fax:
Practice Address - Street 1:200 MADISON AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3218
Practice Address - Country:US
Practice Address - Phone:607-737-6869
Practice Address - Fax:607-737-8054
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120546-7208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8362OtherRR MEDICARE GROUP
NYP00393472OtherRR MEDICARE PIN
NY00372358Medicaid
NYBB5836Medicare ID - Type UnspecifiedM'CARE PROVIDER #
NY00372358Medicaid