Healthcare Provider Details

I. General information

NPI: 1427033216
Provider Name (Legal Business Name): PATRICK MICHAEL HARE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH MEDICAL CLINIC MARINE CORPS AIR STATION, MIRAMAR
SAN DIEGO CA
92145-0001
US

IV. Provider business mailing address

BRANCH MEDICAL CLINIC MARINE CORPS AIR STATION, MIRAMAR
SAN DIEGO CA
92145-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-577-9944
  • Fax:
Mailing address:
  • Phone: 858-577-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103132
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: