Organization
DAVID R. HANTKE, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID R HANTKE (PRESIDENT)
(805) 648-7222
Entity
Organization
Contact information
Practice address
2807 LOMA VISTA RD, STE 103, VENTURA, CA 93003-1500
(805) 648-7222
(805) 648-7235
Mailing address
2807 LOMA VISTA RD, STE 103, VENTURA, CA 93003-1500
(805) 648-7222
(805) 648-7235
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G48701
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G487010
BLUE SHIELD
CA
05
—
00G487010
—
CA
01
—
040014777
RAILROAD MEDICARE
CA
01
—
06B6953
TRICARE
CA
01
—
DH0826
GROUP RAILROAD MEDICARE NUMBER
CA
01
—
G48701
BLUE CROSS
CA
01
—
WG48701C
MEDICARE INDIVIDUAL PTAN
CA
Enumeration date
08/11/2005
Last updated
07/17/2012
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