Provider Demographics
NPI:1639575483
Name:HUNT, GLENN S
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:S
Last Name:HUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 W DESERT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2703
Mailing Address - Country:US
Mailing Address - Phone:623-487-3040
Mailing Address - Fax:
Practice Address - Street 1:5439 W DESERT HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2703
Practice Address - Country:US
Practice Address - Phone:623-487-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory