Healthcare Provider Details

I. General information

NPI: 1689845505
Provider Name (Legal Business Name): DOUGLAS D. HUNTER, M.D.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FIFTH STREET
RACINE OH
45771
US

IV. Provider business mailing address

207 FIFTH STREET P.O. BOX 458
RACINE OH
45771
US

V. Phone/Fax

Practice location:
  • Phone: 740-949-2683
  • Fax: 740-949-2462
Mailing address:
  • Phone: 740-949-2683
  • Fax: 740-949-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35052295
License Number StateOH

VIII. Authorized Official

Name: DOUGLAS D HUNTER
Title or Position: OWNER
Credential: M.D.
Phone: 740-949-2683