Provider Demographics
NPI:1104895507
Name:HUNSAKER, JESSE N (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:N
Last Name:HUNSAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2952
Mailing Address - Country:US
Mailing Address - Phone:801-756-9627
Mailing Address - Fax:801-763-0216
Practice Address - Street 1:12 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-756-9627
Practice Address - Fax:801-763-0216
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167725-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1104895507Medicaid
UTP00039729OtherRAILROAD MEDICARE
UT005566401OtherUNITED AMERICAN
UT107006213101OtherSELECT HEALTH
UT206802OtherALTIUS
UT4116795OtherAETNA
UT6426OtherPEHP
UT870283576HUNOtherEDUCATORS MUTUAL
UT87028357684003A003OtherTRICARE
UT870283576HOtherFIRST HEALTH
UT36172OtherMEDADVANTAGE
UTC63509Medicare UPIN
UT005566401OtherUNITED AMERICAN