Basic Information
| Provider Information | |||||||||
| NPI: | 1639511819 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN DAVID HANSILL, M.D., PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 07/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | HANSILL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5418892229 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD153764 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.