Healthcare Provider Details

I. General information

NPI: 1982714291
Provider Name (Legal Business Name): ROBERT ANTHONY HANSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E OLYMPIA AVE SUITE 211
PUNTA GORDA FL
33950-3833
US

IV. Provider business mailing address

315 E OLYMPIA AVE SUITE 211
PUNTA GORDA FL
33950-3833
US

V. Phone/Fax

Practice location:
  • Phone: 941-637-2663
  • Fax: 941-637-6872
Mailing address:
  • Phone: 941-637-2663
  • Fax: 941-637-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME68317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: