Provider Demographics
NPI:1649368259
Name:HATTER, DOUGLAS G (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:HATTER
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 1:2510 AIRPARK DR
Mailing Address - Street 2:STE 301
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-242-3500
Mailing Address - Fax:530-242-3546
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:STE 301
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-242-3500
Practice Address - Fax:530-242-3546
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70383208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703830Medicaid
00G703830Medicare ID - Type Unspecified
CAG86740Medicare UPIN