Provider Demographics
NPI:1992705024
Name:HUDDLESTON, RODNEY L (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:L
Last Name:HUDDLESTON
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:CHICKASAW NATION HEALTH SYSTEM
Mailing Address - Street 2:1001 NORTH COUNTRY CLUB ROAD
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:800-851-9136
Mailing Address - Fax:
Practice Address - Street 1:CHICKASAW NATION HEALTH SYSTEM
Practice Address - Street 2:1001 NORTH COUNTRY CLUB ROAD
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:800-851-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328898Medicaid
LA5M207Medicare ID - Type Unspecified
LA1328898Medicaid