Provider Demographics
NPI:1376591313
Name:HOKANSON, THOMAS C (PA C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:HOKANSON
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 B JOHN B WHITE SR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3927
Mailing Address - Country:US
Mailing Address - Phone:864-574-0017
Mailing Address - Fax:864-574-6088
Practice Address - Street 1:1410 B JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3927
Practice Address - Country:US
Practice Address - Phone:864-574-0017
Practice Address - Fax:864-574-6088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q31730Medicare UPIN