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General NPI Number Information
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NPI Number | 1487074472
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Entity Type | Individual
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Provider Name | ALLAN THOMAS HANRETTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/19/2014
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Provider Practice Location Address
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Address Line | 3401 N UNIVERSITY AVE
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City | LUBBOCK
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State | TX
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Zip | 79415-1734
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Country | US
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Telephone | 806-741-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 N UNIVERSITY AVE
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City | LUBBOCK
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State | TX
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Zip | 79415-1734
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Country | US
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Telephone | 806-741-3789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | H8108
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License Number State | TX
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