Provider Demographics
NPI:1386644920
Name:HANES, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:HANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1334 W COVINA BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3211
Mailing Address - Country:US
Mailing Address - Phone:909-599-0881
Mailing Address - Fax:909-394-0701
Practice Address - Street 1:1334 W COVINA BLVD
Practice Address - Street 2:STE 105
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:909-599-0881
Practice Address - Fax:909-394-0701
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG47702207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89865Medicare UPIN
CAW18432Medicare ID - Type Unspecified