Provider Demographics
NPI:1750407607
Name:HUNTER, ELIZABETH DIANN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIANN
Last Name:HUNTER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2817 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1629
Mailing Address - Country:US
Mailing Address - Phone:417-782-5522
Mailing Address - Fax:417-206-9599
Practice Address - Street 1:2817 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-782-5522
Practice Address - Fax:417-206-9599
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MO20001521612080A0000X
KS04-245752080A0000X
OK157222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57197Medicare UPIN