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Individual

MATTHEW DAVID HUCKABY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
969 LAKELAND DRIVE, EMERGENCY DEPARTMENT, JACKSON, MS 39216
(601) 200-6175
(601) 200-2020
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-6175
(601) 200-2020

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
24709
MS
207P00000X
Emergency Medicine Physician
MD.208248
LA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
08627073
MS
Enumeration date
04/09/2014
Last updated
06/08/2020
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