Provider Demographics
NPI:1831518406
Name:HUNT, STEPHEN MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:HUNT
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 1:7391 W CHARLESTON BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1577
Mailing Address - Country:US
Mailing Address - Phone:702-823-4255
Mailing Address - Fax:702-823-3625
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:HMC 3.EC.27, BOX 359702
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17841207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1831518406Medicaid
CA1831518406Medicaid
NV1831518406Medicaid
UT3009807Medicaid