Provider Demographics
NPI:1639237068
Name:HUNTER, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:HUNTER
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 1:2117 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3314
Mailing Address - Country:US
Mailing Address - Phone:541-808-9000
Mailing Address - Fax:541-808-9001
Practice Address - Street 1:2117 UNION AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3314
Practice Address - Country:US
Practice Address - Phone:541-808-9000
Practice Address - Fax:541-808-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01428006OtherRR MEDICARE
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORP00389915OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherGROUP PIN NUMBER
OR930635514OtherGROUP TAX ID FOR BILLING
ORR177736OtherMEDICARE PTAN
OR930635514OtherGROUP TAX ID FOR BILLING
ORP01428006OtherRR MEDICARE
ORH35357Medicare UPIN