Basic Information
| Provider Information | |||||||||
| NPI: | 1770567273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUFFARD | ||||||||
| FirstName: | ELLIOTT | ||||||||
| MiddleName: | CLAY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 203057 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772163057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813588114 | ||||||||
| FaxNumber: | 2813580609 | ||||||||
| Practice Location | |||||||||
| Address1: | 8850 LONG POINT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770553006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138271820 | ||||||||
| FaxNumber: | 7134687370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 367500000X | 633667 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 049543 | 01 | AANA RECERTIFICATION | OTHER | 81021U | 01 | TX | BLUE CROSS/BLUE SHIELD | OTHER |