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General NPI Number Information
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NPI Number | 1881637023
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Entity Type | Individual
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Provider Name | CHRISTIAN HACKSHAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 5176 HILL RD E EMERGENCY DEPARTMENT
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-262-5050
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Fax | 707-262-5053
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Provider Business Mailing Address
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Address Line | 3843 GLEBE RD
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City | KELSEYVILLE
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State | CA
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Zip | 95451-8251
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Country | US
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Telephone | 707-295-6080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C51195
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License Number State | CA
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