Provider Demographics
NPI:1366701229
Name:HUFFORD, THEADORE A JR (MD)
Entity type:Individual
Prefix:
First Name:THEADORE
Middle Name:A
Last Name:HUFFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLZ STE 666
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-7143
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:9413 FLATLANDS AVE STE 201
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3726
Practice Address - Country:US
Practice Address - Phone:718-240-8446
Practice Address - Fax:718-240-5808
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.130486208600000X
IL036138222086S0127X, 2086S0127X
NY292811208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292811OtherLICENSE