Provider Demographics
NPI:1699139089
Name:ALTMAN, HUNTER UTKOV (MD)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:UTKOV
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HUNTER
Other - Middle Name:ELIZABETH
Other - Last Name:UTKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:210-358-5909
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-5909
Practice Address - Fax:210-358-5940
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57044208000000X
SC51328208000000X
TXU4456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300066705Medicaid
SC513288Medicaid
KY7100842840Medicaid
KY57044OtherSTATE LICENSE