Provider Demographics
NPI:1568677623
Name:JOHN B HACKERT MD INC
Entity Type:Organization
Organization Name:JOHN B HACKERT MD INC
Other - Org Name:SIERRA COLORECTAL SURGERY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HACKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-984-9700
Mailing Address - Street 1:4413 SOPHISTRY DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8073
Mailing Address - Country:US
Mailing Address - Phone:916-682-8289
Mailing Address - Fax:
Practice Address - Street 1:1641 CREEKSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3831
Practice Address - Country:US
Practice Address - Phone:916-984-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82374208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty