Individual
JOHN HAUSDORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 HARRIS CT, BLDG T, 2ND FLR SUITE 201, MONTEREY, CA 93940
(831) 375-4105
(831) 372-5722
Mailing address
5 HARRIS CT # 201, BLDG T, 2ND FLR, MONTEREY, CA 93940-5750
(831) 375-4105
(831) 372-5722
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
G72868
CA
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
113577
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G728680
BCBS
—
05
—
00G728680
—
CA
01
—
GR0080140
MEDICAID GROUP #
—
01
—
ZZZ13460Z
MEDICARE GROUP #
—
Enumeration date
06/01/2006
Last updated
05/23/2018
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