Provider Demographics
NPI:1235252248
Name:HACKER, GAIL JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:JEAN
Last Name:HACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2356
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:541-342-6088
Practice Address - Street 1:3579 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2356
Practice Address - Country:US
Practice Address - Phone:541-344-9411
Practice Address - Fax:541-342-6088
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 21490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151323Medicaid
001100609Medicare UPIN