Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 33820 | FL |
Y | 213ES0000X | Sports Medicine | 33820 | FL |
NPI | 1013566165 |
---|---|
Provider Name | Jordan Lee Huffman |
First Address | Sergeant Bluff, IA 51054-8922 |
Second Address | Brandon, FL 33511-8101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 10/09/2019 |