Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 25304 | AZ |
NPI | 1164478731 |
---|---|
Provider Name | Hany Hannallah |
First Address | Phoenix, AZ 85027-3943 |
Second Address | Sun City, AZ 85351-3058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165375 | (05) | AZ |