Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD26119 | OR |
NPI | 1336235019 |
---|---|
Provider Name | John Richard Hannig |
First Address | Salem, OR 97301-3975 |
Second Address | Salem, OR 97301-3975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52787 | (02) | CA |