Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME76954 | FL |
NPI | 1083701437 |
---|---|
Provider Name | Mr. Robert L. Hannan |
First Address | Miami, FL 33255 |
Second Address | Miami, FL 33155-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 24/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255205100 | (05) | FL |
B77215 | (02) | FL |
K6961 | (02) | FL |