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General NPI Number Information
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NPI Number | 1700885811
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Entity Type | Individual
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Provider Name | HOMER PAUL HATTEN JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1485 37TH ST SUITE 107
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City | VERO BEACH
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State | FL
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Zip | 32960-6500
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Country | US
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Telephone | 772-569-9745
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Fax | 772-567-6868
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Provider Business Mailing Address
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Address Line | 111 TWIN ISLAND REACH
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City | VERO BEACH
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State | FL
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Zip | 32963-3909
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Country | US
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Telephone | 772-231-3453
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Fax | 772-231-8986
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME0076679
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME0076679
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License Number State | FL
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