Provider Demographics
NPI:1649664087
Name:COLIN HAMBLIN, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:COLIN HAMBLIN, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:COLIN
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-663-1082
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:11150 STATE ROUTE 1
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0240
Mailing Address - Country:US
Mailing Address - Phone:415-663-1082
Mailing Address - Fax:415-663-9474
Practice Address - Street 1:11150 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-1082
Practice Address - Fax:415-663-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty