Healthcare Provider Details

I. General information

NPI: 1497259006
Provider Name (Legal Business Name): THOMAS HANNA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 801
SPOKANE WA
99204-2974
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5120
  • Fax: 509-755-5551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOP61463449
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: