Provider Demographics
NPI:1851337158
Name:HUNT, GORDON CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:CHARLES
Last Name:HUNT
Suffix:JR
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 1:2200 RIVER PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-4134
Mailing Address - Country:US
Mailing Address - Phone:916-286-6622
Mailing Address - Fax:916-286-8108
Practice Address - Street 1:2200 RIVER PLAZA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-4134
Practice Address - Country:US
Practice Address - Phone:916-286-6622
Practice Address - Fax:916-286-8108
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36208207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46610Medicare UPIN
CA00G362080Medicare ID - Type Unspecified