Provider Demographics
NPI:1548221880
Name:HUNT, LISA BREE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BREE
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 1:9305 W THOMAS RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-889-6186
Mailing Address - Fax:623-889-6188
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:STE 450
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-889-6186
Practice Address - Fax:623-889-6188
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928129Medicaid
Z104468Medicare PIN
AZ928129Medicaid
AZ104468Medicare UPIN
I35882Medicare UPIN