Provider Demographics
NPI:1487604302
Name:HUNTLEY, DOUGLAS BRETT (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRETT
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1027 FLEMING STREET
Mailing Address - Street 2:STE B
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3534
Mailing Address - Country:US
Mailing Address - Phone:828-693-1436
Mailing Address - Fax:828-693-1107
Practice Address - Street 1:1027 FLEMING STREET
Practice Address - Street 2:STE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3534
Practice Address - Country:US
Practice Address - Phone:828-693-1436
Practice Address - Fax:828-693-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200571944OtherCIGNA
200571944OtherCRESENT
200571944OtherFIRST HEALTH
200571944OtherHEALTH CARE SAVINGS
200571944OtherUNITED HEALTH CARE
NC5900653Medicaid
200571944OtherTRICARE
200571944OtherMEDCOST
45070OtherBCBS
200571944OtherCIGNA
200571944OtherTRICARE