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NPI Code Detail

MEDICARE: MR. RYAN D HASTINGS PA

MEDICARE:  MR. RYAN D HASTINGS  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA19871CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00847996OTHERCARAILROAD MEDICARE

General Provider Information

NPI Number : 1912984113
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN D HASTINGS PA
Provider Business Mailing Address
First Line : 600 COFFEE RD
Second Line :
City : MODESTO
State : CA
Zip : 95355-4201
Country : US
Telephone Number : 209-521-6097
Fax Number :
Provider Business Practice Location Address
First Line : 2545 W HAMMER LN
Second Line :
City : STOCKTON
State : CA
Zip : 95209-2839
Country : US
Telephone Number : 209-957-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 01/04/2013

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Directions to “ MR. RYAN D HASTINGS PA” Practice Location

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