Healthcare Provider Details

I. General information

NPI: 1952384810
Provider Name (Legal Business Name): PATRICK KYRAN HUNTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5834 BERRYHILL RD
MILTON FL
32570-8275
US

IV. Provider business mailing address

4951 GRANDE DR
PENSACOLA FL
32504-8965
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-5437
  • Fax: 850-626-7803
Mailing address:
  • Phone: 850-623-5437
  • Fax: 850-626-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number98-00068
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-9112
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME124334
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME124334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: