Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | R75732 | AZ |
NPI | 1013365675 |
---|---|
Provider Name | Philipp Lorenz Hannan |
First Address | Tucson, AZ 85714-2099 |
Second Address | Tucson, AZ 85714-2099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 24/05/2016 |