Provider Demographics
NPI:1619047412
Name:HUNTER, DEBORAH ROSE (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ROSE
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 1:29 PARK PLACE
Mailing Address - Street 2:APT #208
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1561
Mailing Address - Country:US
Mailing Address - Phone:601-599-3306
Mailing Address - Fax:
Practice Address - Street 1:CAMP SHELBY
Practice Address - Street 2:TROOP MEDICAL CLINIC BLDG 1302
Practice Address - City:CAMP SHELBY
Practice Address - State:MS
Practice Address - Zip Code:39407-5500
Practice Address - Country:US
Practice Address - Phone:601-558-2221
Practice Address - Fax:601-558-2445
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14911R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G03869Medicare UPIN