Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1676 | AL |
Y | 213ES0000X | Sports Medicine | 1676 | AL |
NPI | 1336676352 |
---|---|
Provider Name | Matthew Michael Hanks |
First Address | Auburn, AL 36832-4339 |
Second Address | Auburn, AL 36849-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 17/03/2018 |