Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A163113 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A163113 | CA |
NPI | 1679986772 |
---|---|
Provider Name | John Edward Hanks |
First Address | Jamaica Plain, MA 02130-4817 |
Second Address | Jamaica Plain, MA 02130-4817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 21/10/2020 |