Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901009615 | MI |
NPI | 1013321165 |
---|---|
Provider Name | Dr. Raymond James Hanna |
First Address | West Bloomfield, MI 48324-2534 |
Second Address | West Bloomfield, MI 48324-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 30/09/2014 |