Provider Demographics
NPI:1871582973
Name:HUFFMAN, ROSS O (DO)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:O
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2924
Mailing Address - Country:US
Mailing Address - Phone:641-754-5040
Mailing Address - Fax:641-754-5153
Practice Address - Street 1:3 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2924
Practice Address - Country:US
Practice Address - Phone:641-754-5040
Practice Address - Fax:641-754-5153
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0153536Medicaid
IAG39032Medicare UPIN
IAI21703Medicare PIN