Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30-01-5310 | OH |
NPI | 1649378233 |
---|---|
Provider Name | Dr. James Warren Hanna |
First Address | Ashtabula, OH 44004-6623 |
Second Address | Ashtabula, OH 44004-6623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0336872 | (05) | OH |
T-46879 | (02) | OH |