Provider Demographics
NPI:1053331785
Name:HOBBS, DONALD RUSSELL (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RUSSELL
Last Name:HOBBS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RUSS
Other - Middle Name:
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93421-0513
Mailing Address - Country:US
Mailing Address - Phone:805-929-2015
Mailing Address - Fax:
Practice Address - Street 1:292 POSADA LN
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4054
Practice Address - Country:US
Practice Address - Phone:805-434-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11450363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical