Provider Demographics
NPI:1063437101
Name:HUNT, GORDON C (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:C
Last Name:HUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:DIVISION OF GASTROENTEROLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-6550
Mailing Address - Fax:619-528-5999
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8413
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-543-5227
Practice Address - Fax:619-543-2766
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60612207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606120Medicaid
CAWA60612AMedicare ID - Type Unspecified
CAH45347Medicare UPIN