Healthcare Provider Details

I. General information

NPI: 1316960420
Provider Name (Legal Business Name): HAL L HANKINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 107
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

465 SAINT MICHAELS DR SUITE 107
SANTA FE NM
87505-7670
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3233
  • Fax: 505-988-3562
Mailing address:
  • Phone: 505-988-3233
  • Fax: 505-988-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number75163
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: