Healthcare Provider Details

I. General information

NPI: 1114095106
Provider Name (Legal Business Name): BASIL COLIN HAMBLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 STATE ROUTE ONE
POINT REYES STATION CA
94956
US

IV. Provider business mailing address

PO BOX 240 11150 STATE ROUTE ONE
POINT REYES STATION CA
94956
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-8666
  • Fax:
Mailing address:
  • Phone: 415-663-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76893
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA76893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: