MEDICARE: DR. SAMEH W HANNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	25941	OK

General Provider Information

NPI Number	:	1922182336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMEH W HANNA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 785
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73502-0785
Country	:	US
Telephone Number	:	580-357-9984
Fax Number	:	580-357-3277

Provider Business Practice Location Address
First Line	:	3201 W GORE BLVD STE 104
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6350
Country	:	US
Telephone Number	:	580-250-6659
Fax Number	:	580-250-5249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/21/2017

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