Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125067867 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 66592 | MN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 73144 | WI |
NPI | 1417339375 |
---|---|
Provider Name | Charles Patrick Hannon |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 25/08/2020 |