Provider Demographics
NPI:1568485787
Name:HAHN, PHILIP JOHN JR (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:HAHN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 RICHMOND RD # 62
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2123
Mailing Address - Country:US
Mailing Address - Phone:903-791-1222
Mailing Address - Fax:903-791-8310
Practice Address - Street 1:5606 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-791-1222
Practice Address - Fax:903-791-8310
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR126213ES0103X
TX1134213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59921OtherBLUE CROSS/BLUE SHIELD
TX018709801Medicaid
TX8BF021OtherBLUE CROSS BLUE SHIELD
AR128263717Medicaid
TX00G19CMedicare PIN
AR128263717Medicaid