Provider Demographics
NPI:1184619314
Name:HUFF, WALLACE L JR (MD)
Entity type:Individual
Prefix:
First Name:WALLACE
Middle Name:L
Last Name:HUFF
Suffix:JR
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 1:3480 YORKSHIRE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-263-5140
Mailing Address - Fax:859-263-5141
Practice Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-263-5140
Practice Address - Fax:859-263-5141
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA050892207X00000X
KY40622207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6407358Medicaid
000000515699OtherANTHEM
KY64015365Medicaid
KYP00393403OtherRAILROAD MEDICARE
VA200001022Medicare ID - Type Unspecified
VABH4063020Medicare UPIN
KY64015365Medicaid
KYP00393403OtherRAILROAD MEDICARE
KYF86915Medicare UPIN
KY0658613Medicare PIN