1912769787 NPI number — MR. TIMOTHY MARLOW HUNT ABC PEDORTHIST 1070

Table of content: MR. TIMOTHY MARLOW HUNT ABC PEDORTHIST 1070 (NPI 1912769787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912769787 NPI number — MR. TIMOTHY MARLOW HUNT ABC PEDORTHIST 1070

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNT
Provider First Name:
TIMOTHY
Provider Middle Name:
MARLOW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ABC PEDORTHIST 1070
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:
1912769787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SMOKING OAKS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEWOKA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74884-3465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-633-3217
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11990 N HIGHWAY 99
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEMINOLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74868-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-633-3217
Provider Business Practice Location Address Fax Number:
405-683-6027
Provider Enumeration Date:
01/26/2024

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: 224L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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