Provider Demographics
NPI:1073518379
Name:HUNTER, JOHN DANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANE
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 1:3 BUTTERNUT DR
Mailing Address - Street 2:STE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4653
Mailing Address - Country:US
Mailing Address - Phone:864-298-2826
Mailing Address - Fax:864-672-7764
Practice Address - Street 1:131 LILA DOYLE DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9495
Practice Address - Country:US
Practice Address - Phone:864-888-3717
Practice Address - Fax:864-888-8486
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT64034Medicaid
SC6526Medicare PIN
SCT64034Medicaid