Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME132199 | FL |
NPI | 1326485723 |
---|---|
Provider Name | Shannon Hahn |
First Address | Tampa, FL 33622-5317 |
Second Address | Winter Park, FL 32789-5499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2013 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020868600 | (05) | FL |
IZ016Z | MEDICARE (01) | FL |