Provider Demographics
NPI:1477539617
Name:HUNT, JILL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:HUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 W PLATT ST # 1
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2038
Mailing Address - Country:US
Mailing Address - Phone:563-652-5145
Mailing Address - Fax:563-652-3674
Practice Address - Street 1:918 W PLATT ST # 1
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2038
Practice Address - Country:US
Practice Address - Phone:563-652-5145
Practice Address - Fax:563-652-3674
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1065284Medicaid
C33867Medicare UPIN
51726Medicare ID - Type Unspecified