Provider Demographics
NPI:1700128543
Name:LISA HUNT, MD, PLC
Entity Type:Organization
Organization Name:LISA HUNT, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-330-3833
Mailing Address - Street 1:PO BOX 5577
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0610
Mailing Address - Country:US
Mailing Address - Phone:623-889-6186
Mailing Address - Fax:623-889-6188
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 450
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-889-6186
Practice Address - Fax:623-889-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928129Medicaid
AZ104468Medicare UPIN