Provider Demographics
NPI:1639511819
Name:JOHN DAVID HANSILL, M.D., PC
Entity Type:Organization
Organization Name:JOHN DAVID HANSILL, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HANSILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-889-2229
Mailing Address - Street 1:1219 SW 4TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4566
Mailing Address - Country:US
Mailing Address - Phone:541-889-2229
Mailing Address - Fax:
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4566
Practice Address - Country:US
Practice Address - Phone:541-889-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty