Provider Demographics
NPI:1154367282
Name:HUFFMAN, BRENT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2343
Mailing Address - Country:US
Mailing Address - Phone:314-996-7080
Mailing Address - Fax:
Practice Address - Street 1:3009 N BALLAS RD STE 102B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2343
Practice Address - Country:US
Practice Address - Phone:314-996-7080
Practice Address - Fax:314-996-7085
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180256952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200462850Medicaid
INP00742312OtherRAILROAD MEDICARE PTAN
IN200462850Medicaid