Basic Information
| Provider Information | |||||||||
| NPI: | 1831551092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATCH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177023431 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7106 SANGER RD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767123928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5425371265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | S8999 | TX | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | S8999 | TX | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.