Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2020019969 | MO |
NPI | 1205444999 |
---|---|
Provider Name | Jared Huffman |
First Address | Kirksville, MO 63501-6401 |
Second Address | Kirksville, MO 63501-6401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2020 |
Last Update Date | 19/07/2020 |