Provider Demographics
NPI:1174575567
Name:HAMRICK, JONATHAN STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STANLEY
Last Name:HAMRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:47 SANTA ROSA ST
Mailing Address - Street 2:47 SANTA ROSA
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5816
Mailing Address - Country:US
Mailing Address - Phone:805-542-9956
Mailing Address - Fax:805-594-1436
Practice Address - Street 1:47 SANTA ROSA ST
Practice Address - Street 2:47 SANTA ROSA
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5816
Practice Address - Country:US
Practice Address - Phone:805-542-9956
Practice Address - Fax:805-594-1436
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA35634MMedicaid
CAFB817ZMedicare PIN
A27858Medicare UPIN