Healthcare Provider Details

I. General information

NPI: 1639575483
Provider Name (Legal Business Name): MR. GLENN S HUNT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 W DESERT HILLS DR
GLENDALE AZ
85304-2703
US

IV. Provider business mailing address

5439 W DESERT HILLS DR
GLENDALE AZ
85304-2703
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-3040
  • Fax:
Mailing address:
  • Phone: 623-487-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: