Provider Demographics
NPI:1528054822
Name:HUNTER, ELISSA J (MD)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:J
Last Name:HUNTER
Suffix:
Gender:F
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:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:110 NW 31ST ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6100
Practice Address - Country:US
Practice Address - Phone:580-510-7042
Practice Address - Fax:580-510-7044
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22510208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020053163OtherRAILROAD MEDICARE
OK7648345OtherAETNA
KS347459110OtherDOL
OK100097930AMedicaid
H68171Medicare UPIN
OK7648345OtherAETNA