1467438952 NPI number — DR. SCOTT ALFRED HUNDAHL M.D.

Table of content: MYLES FREDERICK BRYAN (NPI 1669343174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467438952 NPI number — DR. SCOTT ALFRED HUNDAHL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNDAHL
Provider First Name:
SCOTT
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467438952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10535 HOSPITAL WAY # 112
Provider Second Line Business Mailing Address:
PROFESSOR AND CHIEF OF SURGERY - VA NORTHERN CALIFORNIA
Provider Business Mailing Address City Name:
MATHER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95655-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-843-7174
Provider Business Mailing Address Fax Number:
916-366-5328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SACRAMENTO VA MEDICAL CENTER - CHIEF OF SURGERY
Provider Second Line Business Practice Location Address:
10535 HOSPITAL WAY, SMAT-112
Provider Business Practice Location Address City Name:
MATHER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95655-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-843-7174
Provider Business Practice Location Address Fax Number:
916-366-5328
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  G86699 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086X0206X , with the licence number: MD-5132 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)