Provider Demographics
NPI:1497706717
Name:HAMANN, BRADLEY JAY (PA-C)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAY
Last Name:HAMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6013
Mailing Address - Country:US
Mailing Address - Phone:559-791-7049
Mailing Address - Fax:559-734-1247
Practice Address - Street 1:12586 AVENUE 408
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-9454
Practice Address - Country:US
Practice Address - Phone:559-528-2804
Practice Address - Fax:559-528-7623
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ05011Medicare UPIN