Provider Demographics
NPI:1790726586
Name:HANKS, HOWARD STANLEY
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:STANLEY
Last Name:HANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 REARDON ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9699
Mailing Address - Country:US
Mailing Address - Phone:209-847-0900
Mailing Address - Fax:209-847-0911
Practice Address - Street 1:190 S OAK AVE
Practice Address - Street 2:BLDG 3 STE 2
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3528
Practice Address - Country:US
Practice Address - Phone:209-847-0900
Practice Address - Fax:209-847-0911
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF70552Medicare UPIN
CA00G791430Medicare ID - Type Unspecified