Provider Demographics
NPI:1740284173
Name:HUNTER, GEORGE R (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:HUNTER
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 1:1002 TEXAS BLVD
Mailing Address - Street 2:STE 501
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5117
Mailing Address - Country:US
Mailing Address - Phone:903-792-7515
Mailing Address - Fax:
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:STE 501
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5117
Practice Address - Country:US
Practice Address - Phone:903-792-7515
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T79DMedicare ID - Type Unspecified
TXC17236Medicare UPIN