Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 147195 | AK |
NPI | 1003264029 |
---|---|
Provider Name | Logan F Huff |
First Address | Nome, AK 99762-0966 |
Second Address | Nome, AK 99762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1646441 | (05) | AK |