Provider Demographics
NPI:1487738241
Name:HUFFORD, BRADLEY J (PHD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:HUFFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 POKAGON DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9403
Mailing Address - Country:US
Mailing Address - Phone:317-566-9869
Mailing Address - Fax:
Practice Address - Street 1:4141 SHORE DR
Practice Address - Street 2:REHABILITATION HOSPITAL OF INDIANA
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2607
Practice Address - Country:US
Practice Address - Phone:317-329-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041694A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200381100Medicaid
IN200381100Medicaid