Provider Demographics
NPI:1457343196
Name:HUDDLESTON, JAMES ANDREW (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 E MCMURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5404
Mailing Address - Country:US
Mailing Address - Phone:520-374-6530
Mailing Address - Fax:
Practice Address - Street 1:1811 E MCMURRAY BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5404
Practice Address - Country:US
Practice Address - Phone:520-374-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007221207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157491Medicaid
OHP00445295OtherRAILROAD MEDICARE PTAN
OHHU0895092Medicare PIN
OHP00445295OtherRAILROAD MEDICARE PTAN
OH2157491Medicaid