1528128915 NPI number — DR. JULIA ANNE TATUM HUNTER M.D.

Table of content: DR. JULIA ANNE TATUM HUNTER M.D. (NPI 1528128915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528128915 NPI number — DR. JULIA ANNE TATUM HUNTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATUM HUNTER
Provider First Name:
JULIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNTER
Provider Other First Name:
JULIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528128915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1102 A1A N STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTE VEDRA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32082-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-247-8744
Provider Business Mailing Address Fax Number:
310-247-0181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 FLORIDA A1A NORTH
Provider Second Line Business Practice Location Address:
DR. OZDEMIR OFFICE ST 104
Provider Business Practice Location Address City Name:
PONTE VEDRA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-247-8744
Provider Business Practice Location Address Fax Number:
310-247-0181
Provider Enumeration Date:
12/08/2006

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: 207LP2900X , with the licence number:  G69549 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: G69549 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: ME148252 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G659491 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".