MEDICARE: MR. PATRICK MICHAEL HARE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	103132	NC
2	363A00000X	Physician Assistant	52412	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52412	OTHER	CA	PA LICENSE

General Provider Information

NPI Number	:	1427033216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MICHAEL HARE PA-C

Provider Business Mailing Address
First Line	:	BRANCH MEDICAL CLINIC
Second Line	:	MARINE CORPS AIR STATION, MIRAMAR
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-577-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	BRANCH MEDICAL CLINIC
Second Line	:	MARINE CORPS AIR STATION, MIRAMAR
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-577-9944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	11/01/2022

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