Provider Demographics
NPI:1154301372
Name:HUNT, MICHAEL GRIFFIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRIFFIN
Last Name:HUNT
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 1:321 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1016
Mailing Address - Country:US
Mailing Address - Phone:817-529-9949
Mailing Address - Fax:817-529-9943
Practice Address - Street 1:321 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1016
Practice Address - Country:US
Practice Address - Phone:817-529-9949
Practice Address - Fax:817-529-9943
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152778001Medicaid
TX8G6222OtherBCBS
166926901OtherAMERIGROUP
H83373OtherCOOK CHIPS
8C1590OtherMEDICARE
TX139925100Medicaid
TX166926901Medicaid
3625737OtherAETNA
H83373OtherCIGNA OPTICARE
TX152778001Medicaid
166926901OtherAMERIGROUP