Provider Demographics
NPI:1053327502
Name:HUNTER, MASON BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:BROOKE
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 WINNE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4915
Mailing Address - Country:US
Mailing Address - Phone:406-457-4100
Mailing Address - Fax:406-457-4110
Practice Address - Street 1:2442 WINNE AVE STE 1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4915
Practice Address - Country:US
Practice Address - Phone:406-457-4100
Practice Address - Fax:406-457-4110
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5136207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0075816Medicaid
MT0075816Medicaid
MT1001970001Medicare ID - Type UnspecifiedTRAVELERS MEDICARE
MTM000001992Medicare PIN