Provider Demographics
NPI:1730350323
Name:HAKE, PHILIP ALAN (PA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALAN
Last Name:HAKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 ROCKCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3030
Mailing Address - Country:US
Mailing Address - Phone:205-641-5952
Mailing Address - Fax:
Practice Address - Street 1:2871 ACTON RD STE 100
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2560
Practice Address - Country:US
Practice Address - Phone:205-716-6900
Practice Address - Fax:205-971-5438
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA568363AS0400X
ALPA.568363AS0400X
ALPA-568363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL109941Medicaid
AL109941Medicaid