1043382906 NPI number — MR. CHARLES RAY HUNTER SR. OTR

Table of content: MR. CHARLES RAY HUNTER SR. OTR (NPI 1043382906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043382906 NPI number — MR. CHARLES RAY HUNTER SR. OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTER
Provider First Name:
CHARLES
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
OTR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043382906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
178 LAZY MDW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78070-6171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-394-0649
Provider Business Mailing Address Fax Number:
210-735-9933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12770 CIMARRON PATH
Provider Second Line Business Practice Location Address:
SUITE 132
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78249-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-394-0649
Provider Business Practice Location Address Fax Number:
210-735-9922
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  108049 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com