Individual
MR. JEFFREY GLEN HUXFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 8TH AVE NE, DEMOTTE, IN 46310-9108
(219) 987-3581
(219) 987-7137
Mailing address
PO BOX 20, DEMOTTE, IN 46310-0020
(219) 987-3581
(219) 987-7137
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061998A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200489280
—
IN
01
—
390380G
MEDICARE ID-TYPE UNSPECIFIED
IN
Enumeration date
06/19/2006
Last updated
06/11/2008
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