1619037496 NPI number — DR. JAMES IRVIN HUDDLESTON III M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619037496 NPI number — DR. JAMES IRVIN HUDDLESTON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDDLESTON
Provider First Name:
JAMES
Provider Middle Name:
IRVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619037496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 BROADWAY ST
Provider Second Line Business Mailing Address:
DEPARTMENT OF ORTHOPAEDIC SURGERY
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94063-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-721-7661
Provider Business Mailing Address Fax Number:
650-721-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 BROADWAY ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ORTHOPAEDIC SURGERY
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94063-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-723-5643
Provider Business Practice Location Address Fax Number:
650-721-3404
Provider Enumeration Date:
12/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X , with the licence number:  A90915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)