Individual
LISA A HUDDLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
727 S WAHANNA ROAD, SEASIDE, OR 97138-7735
(503) 717-7556
(503) 717-7476
Mailing address
PO BOX 3397, PORTLAND, OR 97208-3397
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18816
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128335
—
OR
Enumeration date
09/20/2006
Last updated
09/28/2020
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