Provider Demographics
NPI:1841297819
Name:HUCKESTEIN, DANIEL EVANS (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EVANS
Last Name:HUCKESTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-768-2356
Mailing Address - Fax:814-768-2134
Practice Address - Street 1:531 HANNAH ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1209
Practice Address - Country:US
Practice Address - Phone:814-765-2261
Practice Address - Fax:814-765-4421
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009154L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015971810007Medicaid
PAG38790Medicare UPIN
PA0015971810007Medicaid
PAG38790Medicare UPIN