Provider Demographics
NPI:1497742852
Name:HANSON, JAMES HOBART (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HOBART
Last Name:HANSON
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 1:830 TRESTLE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2318
Mailing Address - Country:US
Mailing Address - Phone:510-428-3719
Mailing Address - Fax:510-450-5885
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3719
Practice Address - Fax:510-450-5885
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG536972080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G536970OtherPERSONAL PROVIDER #
CAGR0047690Medicaid
CAA40797Medicare UPIN