Provider Demographics
NPI:1699703157
Name:HUFFMAN, GEORGE RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:RUSSELL
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 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:609-677-7003
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:255 N LAKEMONT AVE STE 207
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3219
Practice Address - Country:US
Practice Address - Phone:407-852-5333
Practice Address - Fax:407-743-3050
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424496207X00000X
FLME152386207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101221027Medicaid
PA086678Medicare PIN
PA101221027Medicaid