Basic Information
Provider Information
NPI: 1003295643
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HATCH
FirstName: DAVID
MiddleName: CHARLES
NamePrefix: DR.
NameSuffix: JR.
Credential: D.P.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5301 E GRANT RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857122805
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 6422 E SPEEDWAY BLVD STE 150
Address2:  
City: TUCSON
State: AZ
PostalCode: 85710
CountryCode: US
TelephoneNumber: 5203183004
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/28/2015
LastUpdateDate: 07/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103XPOD-000890AZY193400000X SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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