Healthcare Provider Details

I. General information

NPI: 1104827609
Provider Name (Legal Business Name): JAMES R. HANNA DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 DAVISON RD
LOCKPORT NY
14094-5338
US

IV. Provider business mailing address

690 DAVISON RD
LOCKPORT NY
14094-5338
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-8711
  • Fax: 716-433-8705
Mailing address:
  • Phone: 716-433-8711
  • Fax: 716-433-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005077
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES ROBERT HANNA
Title or Position: PRESIDENT
Credential: DPM
Phone: 716-433-8711