Individual
RUSSELL LANNY HUNTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 AINSWORTH DRIVE, PRESCOTT, AZ 86301-1614
(928) 776-0325
(928) 776-0405
Mailing address
PO BOX 10730, PRESCOTT, AZ 86304-0730
(928) 776-0325
(928) 776-0405
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
6167
AZ
207N00000X
Dermatology Physician
AZ6167
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206781
—
AZ
01
—
6167
ARIZ LIC
AZ
Enumeration date
05/15/2007
Last updated
02/27/2012
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