Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0075959 | FL |
NPI | 1033106422 |
---|---|
Provider Name | Randolph Gray Hunter |
First Address | Tavares, FL 32778-0000 |
Second Address | Tavares, FL 32778-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 07/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2553716-00 | (05) | FL |
C74470 | (02) | FL |