Healthcare Provider Details

I. General information

NPI: 1407871908
Provider Name (Legal Business Name): DAVID CLARK HATCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

PO BOX 362
NORTH PLATTE NE
69103-0362
US

V. Phone/Fax

Practice location:
  • Phone: 308-647-6444
  • Fax: 308-647-6433
Mailing address:
  • Phone: 308-647-6444
  • Fax: 308-647-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21277
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: