Healthcare Provider Details

I. General information

NPI: 1508059965
Provider Name (Legal Business Name): ELIZABETH T HUNTER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORLANDO AVE SUITE 305
WINTER PARK FL
32789-5543
US

IV. Provider business mailing address

1400 S ORLANDO AVE SUITE 305
WINTER PARK FL
32789-5543
US

V. Phone/Fax

Practice location:
  • Phone: 407-740-6050
  • Fax: 407-740-0588
Mailing address:
  • Phone: 407-740-6050
  • Fax: 407-740-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME46160
License Number StateFL

VIII. Authorized Official

Name: ELIZABETH T HUNTER
Title or Position: OWNER/MD
Credential: MD
Phone: 407-740-6050