Healthcare Provider Details

I. General information

NPI: 1568462521
Provider Name (Legal Business Name): JAMES KEITH HUNTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 S 15TH ST
OZARK MO
65721-9030
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2215
  • Fax: 417-269-2427
Mailing address:
  • Phone: 417-269-2215
  • Fax: 417-269-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2A41
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: