Basic Information
Provider Information
NPI: 1225140940
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNT
FirstName: RICHARD
MiddleName: ALLEN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5184 MARBLE CT SE
Address2:  
City: SALEM
State: OR
PostalCode: 973062525
CountryCode: US
TelephoneNumber: 5033622463
FaxNumber:  
Practice Location
Address1: 665 WINTER ST SE
Address2:  
City: SALEM
State: OR
PostalCode: 973013919
CountryCode: US
TelephoneNumber: 5035615200
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD20710ORY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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