Basic Information
| Provider Information | |||||||||
| NPI: | 1245290089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUHTA | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD FACC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 N MESA AVE | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 N MESA AVE | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702521020 | ||||||||
| FaxNumber: | 9702521041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35336 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 35336 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 01353366 | 05 | CO | MEDICAID | 35336 | 01 | CO | STATE OF COLORADO LICENSE | OTHER | BH3076848 | 01 | US DEPT OF JUSTICE DEA | OTHER |