Individual
DR. JASON MARSHALL HIATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1401 SPANOS CT, SUITE 104, MODESTO, CA 95355-2810
(209) 525-3150
(209) 525-3153
Mailing address
PO BOX 4512, WALNUT CREEK, CA 94596-0512
(925) 934-3536
(925) 934-0672
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
E4350
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4350
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E43500
BLUE SHIELD
CA
05
—
000E43500
—
CA
01
—
480033874
RAILROAD MEDICARE
CA
Enumeration date
09/20/2006
Last updated
04/24/2009
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