Healthcare Provider Details

I. General information

NPI: 1407167521
Provider Name (Legal Business Name): ADAM EUGENE HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 13TH ST 3N3409
OKLAHOMA CITY OK
73104-5008
US

IV. Provider business mailing address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4417
  • Fax:
Mailing address:
  • Phone: 405-949-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number27956
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27956
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: