Healthcare Provider Details

I. General information

NPI: 1598030637
Provider Name (Legal Business Name): LISA M HUNT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO MSC10 6000
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

212 ALISO DR SE
ALBUQUERQUE NM
87108-2763
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax: 505-272-1300
Mailing address:
  • Phone: 713-206-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2013-0664
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: