Provider Demographics
NPI:1851416010
Name:HUNT, TONY S (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:S
Last Name:HUNT
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 1:9405 FAIRWAY VIEW PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0932
Mailing Address - Country:US
Mailing Address - Phone:909-481-7345
Mailing Address - Fax:909-484-8661
Practice Address - Street 1:9405 FAIRWAY VIEW PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0932
Practice Address - Country:US
Practice Address - Phone:909-481-7345
Practice Address - Fax:909-484-8661
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO674442083X0100X
CAG067444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07334ZMedicare PIN
CABM133ZMedicare UPIN