Healthcare Provider Details

I. General information

NPI: 1417395864
Provider Name (Legal Business Name): OLIVER M HASEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 DOCTORS DRIVE
PANAMA CITY FL
32405
US

IV. Provider business mailing address

202 DOCTORS DRIVE
PANAMA CITY FL
32405
US

V. Phone/Fax

Practice location:
  • Phone: 850-234-7961
  • Fax: 850-235-8948
Mailing address:
  • Phone: 850-234-7961
  • Fax: 850-235-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. OLIVER M HASEK
Title or Position: OWNER
Credential: MD
Phone: 850-235-8948