Provider Demographics
NPI:1174523526
Name:HUFF, ANTHONY G (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:HUFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 LOVE DR
Mailing Address - Street 2:APT. 912
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4007
Mailing Address - Country:US
Mailing Address - Phone:703-343-0673
Mailing Address - Fax:972-910-0511
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:817-481-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03055363A00000X
TXPA02398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
139NL255Medicare ID - Type Unspecified