Healthcare Provider Details

I. General information

NPI: 1255342994
Provider Name (Legal Business Name): GREGORY PAUL HANES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE SUITE 701
SARASOTA FL
34239
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-2160
  • Fax: 941-487-2170
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME88942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: