Provider Demographics
NPI:1316932429
Name:HUFFMAN, MAURICE DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:DEAN
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0850
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-764-0553
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2017-05-01
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-17
Provider Licenses
StateLicense IDTaxonomies
IA202802085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34737600Medicaid
IA04719OtherWELLMARK OFFICE LOCATION
IA1725093Medicaid
IA28892OtherWELLMARK FINLEY LOCATION
IA28893OtherWELLMARK MAQUOKETA LOCATI
IA0725093Medicaid
IA2725093Medicaid
IA2725093Medicaid
IA0725093Medicaid
IA2725093Medicaid
WI0010Medicare ID - Type UnspecifiedWPS WI MEDICARE