Provider Demographics
NPI:1740642180
Name:HUNT, DEREK
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
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 1:709 SUGAR BEND CIR SW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-5311
Mailing Address - Country:US
Mailing Address - Phone:904-233-7038
Mailing Address - Fax:
Practice Address - Street 1:709 SUGAR BEND CIR SW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-5311
Practice Address - Country:US
Practice Address - Phone:904-233-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207PE0004X207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services