Provider Demographics
NPI:1740242866
Name:HUNT, RUSSELL LEE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LEE
Last Name:HUNT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:305 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HELPER
Practice Address - State:UT
Practice Address - Zip Code:84526-1535
Practice Address - Country:US
Practice Address - Phone:435-472-7000
Practice Address - Fax:435-472-3208
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3082820-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant