Provider Demographics
NPI:1184873077
Name:ROBERTA S HUNTER MD PA
Entity type:Organization
Organization Name:ROBERTA S HUNTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYHSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:772-871-9502
Mailing Address - Street 1:PO BOX 880457
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0457
Mailing Address - Country:US
Mailing Address - Phone:772-871-9502
Mailing Address - Fax:772-871-1235
Practice Address - Street 1:1860 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5545
Practice Address - Country:US
Practice Address - Phone:772-871-9502
Practice Address - Fax:772-871-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty