Provider Demographics
NPI:1760458640
Name:HUNT, CORBIN Q (MD)
Entity Type:Individual
Prefix:
First Name:CORBIN
Middle Name:Q
Last Name:HUNT
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 1:1300 W TERRELL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2820
Mailing Address - Country:US
Mailing Address - Phone:817-820-4906
Mailing Address - Fax:817-820-4815
Practice Address - Street 1:1300 W TERRELL AVE FL 2
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2820
Practice Address - Country:US
Practice Address - Phone:817-820-4906
Practice Address - Fax:817-820-4815
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18190207R00000X
TXM4823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00605081Medicaid
TX8X7933OtherBCBS
TX184732901Medicaid
TX184732902Medicaid
TX184732902Medicaid
TX8J2885Medicare PIN
MSH97848Medicare UPIN
TX184732901Medicaid