Healthcare Provider Details

I. General information

NPI: 1770576076
Provider Name (Legal Business Name): MORRIS R HANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE SUITE 260
TAMPA FL
33609-4181
US

IV. Provider business mailing address

508 S HABANA AVE SUITE 260
TAMPA FL
33609-4181
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-9191
  • Fax: 813-876-3103
Mailing address:
  • Phone: 813-876-9191
  • Fax: 813-876-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0036666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: