Basic Information
Provider Information
NPI: 1871963074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNTER
FirstName: ZACHARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 123 S 27TH ST
Address2:  
City: BILLINGS
State: MT
PostalCode: 591014227
CountryCode: US
TelephoneNumber: 4062473350
FaxNumber: 4062473389
Practice Location
Address1: 440 SAINT MICHAELS DR
Address2: CSVMG PHYSICIAN PRACTICES
City: SANTA FE
State: NM
PostalCode: 875057602
CountryCode: US
TelephoneNumber: 5059133233
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/30/2015
LastUpdateDate: 02/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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