Provider Demographics
NPI:1437120854
Name:FAWLEY, HOWARD HUFF JR (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:HUFF
Last Name:FAWLEY
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:P.O. BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:350 NORTH CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2733
Practice Address - Country:US
Practice Address - Phone:386-676-7130
Practice Address - Fax:386-676-7125
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 269042085R0202X
NC194712085R0202X
AK31202085R0202X
HI112372085R0202X
MT97942085R0202X
WAMD000393272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265746500Medicaid
FL64348Medicare ID - Type Unspecified
FL265746500Medicaid