Healthcare Provider Details

I. General information

NPI: 1174575567
Provider Name (Legal Business Name): JONATHAN STANLEY HAMRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SANTA ROSA ST 47 SANTA ROSA
SAN LUIS OBISPO CA
93405-5816
US

IV. Provider business mailing address

47 SANTA ROSA ST 47 SANTA ROSA
SAN LUIS OBISPO CA
93405-5816
US

V. Phone/Fax

Practice location:
  • Phone: 805-542-9956
  • Fax: 805-594-1436
Mailing address:
  • Phone: 805-542-9956
  • Fax: 805-594-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA35634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: