Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | E3272 | CA |
Y | 213ES0000X | Sports Medicine | E3272 | CA |
NPI | 1477664662 |
---|---|
Provider Name | Dr. David Ray Hannaford |
First Address | San Rafael, CA 94903 |
Second Address | San Rafael, CA 94903-3431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |