Provider Demographics
NPI:1477583458
Name:HANPETER, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HANPETER
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 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-898-4900
Mailing Address - Fax:818-898-4990
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-898-4900
Practice Address - Fax:818-898-4990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG838322086S0127X
CAG0838322086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G838320Medicaid
CA810001025OtherMEDICARE RAILROAD
CA00G83820C29OtherCALOPTIMA
CA00G83820OtherINDIVIDUAL BLUE SHIELD
CAG34224Medicare UPIN
CA810001025OtherMEDICARE RAILROAD
CA00G838320Medicaid