Provider Demographics
NPI:1346219656
Name:HUNT, RODERIC T (RPA-C)
Entity Type:Individual
Prefix:
First Name:RODERIC
Middle Name:T
Last Name:HUNT
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E CHAUTAUQUA ST
Mailing Address - Street 2:PO BOX 168
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-0168
Mailing Address - Country:US
Mailing Address - Phone:716-753-7107
Mailing Address - Fax:716-753-7980
Practice Address - Street 1:95 E CHAUTAUQUA ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-0168
Practice Address - Country:US
Practice Address - Phone:716-753-7107
Practice Address - Fax:716-753-7980
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9511905OtherINDEPENDENT HEALTH
NY000570010006OtherBCBSWNY
NY00026518002OtherUNIVERA
NY01274428Medicaid
NY000570010006OtherBCBSWNY
NY9511905OtherINDEPENDENT HEALTH