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General NPI Number Information
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NPI Number | 1598298135
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Entity Type | Individual
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Provider Name | ZACK HUNTER IDMT
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Gender | Male
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 3278 MITCHELL BLVD
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City | MOODY AFB
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State | GA
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Zip | 31699-1062
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Country | US
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Telephone | 229-257-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 90 HOPE DR BLDG 6000
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City | MOUNTAIN HOME AFB
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State | ID
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Zip | 83648-1062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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