Individual
DR. DAVID RANDALL HANTKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2807 LOMA VISTA RD, SUITE 103, VENTURA, CA 93003-1500
(805) 648-7222
(805) 648-7235
Mailing address
2807 LOMA VISTA RD, SUITE 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
INDIVIDUAL MEDICARE PTAN
CA
Enumeration date
04/24/2007
Last updated
07/17/2012
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