Provider Demographics
NPI:1801848338
Name:HUFFMAN, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:HUFFMAN
Suffix:
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 1:862 BUCKEYE CT
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2772
Mailing Address - Country:US
Mailing Address - Phone:937-238-8912
Mailing Address - Fax:
Practice Address - Street 1:862 BUCKEYE CT
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2772
Practice Address - Country:US
Practice Address - Phone:937-238-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073343A207Q00000X
OH065327H207P00000X
TXT1102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0946589Medicaid
OH000000302752OtherBCBS
OH000000502159OtherANTHEM
OHP00390485OtherMEDICARE RAIL ROAD
OH000000493499OtherANTHEM/BCBS
P00109252OtherRAIL ROAD MEDICARE
OHP00390485OtherMEDICARE RAIL ROAD
OH0946589Medicaid
OH000000502159OtherANTHEM
OHHU0825449Medicare PIN