Healthcare Provider Details

I. General information

NPI: 1679552319
Provider Name (Legal Business Name): ROBERT DEAN HUNT III ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ MS 7000
CAPE GIRARDEAU MO
63701-4710
US

IV. Provider business mailing address

1973 DAVID ST
CAPE GIRARDEAU MO
63701-2392
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-5084
  • Fax:
Mailing address:
  • Phone: 573-332-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000173560
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: