Healthcare Provider Details

I. General information

NPI: 1972952703
Provider Name (Legal Business Name): BENJAMIN NEIL HUNTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NE MARY ROSE PL STE 120
BEND OR
97701-7132
US

IV. Provider business mailing address

2450 NE MARY ROSE PL STE 120
BEND OR
97701-7132
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-7056
  • Fax: 541-385-4935
Mailing address:
  • Phone: 541-382-3100
  • Fax: 541-385-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD219874
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: