Basic Information
| Provider Information | |||||||||
| NPI: | 1073518379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 BUTTERNUT DR | ||||||||
| Address2: | STE B | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642982826 | ||||||||
| FaxNumber: | 8646727764 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 LILA DOYLE DR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296729495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648883717 | ||||||||
| FaxNumber: | 8648888486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 22207 | SC | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | T64034 | 05 | SC | MEDICAID |