Healthcare Provider Details

I. General information

NPI: 1205814589
Provider Name (Legal Business Name): OLIVER MARTIN HASEK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 HOSPITAL DR
BONIFAY FL
32425-4264
US

IV. Provider business mailing address

7205 THOMAS DR # 1906
PANAMA CITY BEACH FL
32408-7501
US

V. Phone/Fax

Practice location:
  • Phone: 850-547-8000
  • Fax:
Mailing address:
  • Phone: 850-387-6290
  • Fax: 850-234-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61068
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number61068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: