Individual
ROLAND KEITH HUFFAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1319 SUNSET DR, SUITE 103, JOHNSON CITY, TN 37604
(423) 439-7246
(423) 282-4698
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-7272
(423) 439-7235
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD44928
TN
207VG0400X
Gynecology Physician
MD44928
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514562
—
TN
01
—
3714470
GROUP MEDICAID #
TN
Enumeration date
07/28/2006
Last updated
01/18/2024
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