Healthcare Provider Details

I. General information

NPI: 1043203706
Provider Name (Legal Business Name): PATRICK HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N CLYDE MORRIS BLVD STE 550-560
DAYTONA BEACH FL
32114-2781
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100265
GAINESVILLE FL
32610-3001
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-2340
  • Fax: 386-258-3284
Mailing address:
  • Phone: 352-273-9000
  • Fax: 352-392-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number39059
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME143543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: