Provider Demographics
NPI:1629169511
Name:HUNDLEY, JAMES RODERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RODERICK
Last Name:HUNDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1177 LOUISIANA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2352
Mailing Address - Country:US
Mailing Address - Phone:407-629-4466
Mailing Address - Fax:407-629-5584
Practice Address - Street 1:1177 LOUISIANA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2352
Practice Address - Country:US
Practice Address - Phone:407-629-4466
Practice Address - Fax:407-629-5584
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 747972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A24946Medicare UPIN