Provider Demographics
NPI:1316973563
Name:HUSTON, DONALD CARL JR (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CARL
Last Name:HUSTON
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1206 W SHERMAN AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6916
Mailing Address - Country:US
Mailing Address - Phone:856-691-8444
Mailing Address - Fax:856-691-8325
Practice Address - Street 1:1206 W SHERMAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6916
Practice Address - Country:US
Practice Address - Phone:856-691-8444
Practice Address - Fax:856-691-8325
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB47363207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1217003Medicaid
NJE53380Medicare UPIN
NJ1217003Medicaid