Provider Demographics
NPI:1215930813
Name:HUCKABEE, RIFE E (MD)
Entity type:Individual
Prefix:
First Name:RIFE
Middle Name:E
Last Name:HUCKABEE
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 1:1111 E SPRUCE AVE STE 431
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-7449
Mailing Address - Fax:
Practice Address - Street 1:1510 E HERNDON AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3333
Practice Address - Country:US
Practice Address - Phone:559-450-6742
Practice Address - Fax:559-450-6743
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL152332085R0202X
CAC1803832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHU000021482Medicaid
AL051021482HUCOtherBC/BS OF AL
AL000021482Medicare PIN
ALF18401Medicare UPIN