Provider Demographics
NPI:1427056936
Name:LARRY W HUFFMAN MD
Entity type:Organization
Organization Name:LARRY W HUFFMAN MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-230-9811
Mailing Address - Street 1:705 E MARSHALL AVE STE 3001
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5610
Mailing Address - Country:US
Mailing Address - Phone:903-230-9811
Mailing Address - Fax:903-653-1431
Practice Address - Street 1:705 E MARSHALL AVE STE 3001
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5610
Practice Address - Country:US
Practice Address - Phone:903-230-9811
Practice Address - Fax:903-653-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123417102Medicaid
TXCK2482OtherRR MEDICARE
TX0080HWOtherBCBS
TX00746TMedicare PIN
TXCK2482OtherRR MEDICARE