Provider Demographics
NPI:1740288190
Name:HUFFMAN, LARRY W (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:W
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E MARSHALL AVE STE 3001
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5610
Mailing Address - Country:US
Mailing Address - Phone:903-230-9811
Mailing Address - Fax:903-653-1431
Practice Address - Street 1:705 E MARSHALL AVE STE 3001
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5610
Practice Address - Country:US
Practice Address - Phone:903-230-9811
Practice Address - Fax:903-653-1431
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123417102Medicaid
TX8G1130OtherBLUE CROSS/BLUE SHIELD
TX752863868OtherTAX ID
TX080177890OtherRAILROAD MEDICARE
TX8076B7Medicare ID - Type UnspecifiedMEDICARE
TX080177890OtherRAILROAD MEDICARE