Provider Demographics
NPI:1396833075
Name:HANCHETT, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:HANCHETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 E CHAMPLAIN DR # 134A
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5030
Mailing Address - Country:US
Mailing Address - Phone:559-323-8200
Mailing Address - Fax:559-323-9200
Practice Address - Street 1:7095 N CHESTNUT AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0360
Practice Address - Country:US
Practice Address - Phone:559-323-8200
Practice Address - Fax:559-323-9200
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44482Medicare UPIN