MEDICARE: DR. EHAB IBRAHIM HANNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	N1245	TX

General Provider Information

NPI Number	:	1063624302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHAB IBRAHIM HANNA MD

Provider Business Mailing Address
First Line	:	921 E FM 1187
Second Line	:	SUITE A
City	:	CROWLEY
State	:	TX
Zip	:	76036-4363
Country	:	US
Telephone Number	:	817-945-1682
Fax Number	:	817-945-1686

Provider Business Practice Location Address
First Line	:	921 E FM 1187 STE A
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4364
Country	:	US
Telephone Number	:	817-945-1682
Fax Number	:	817-945-1686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	11/01/2019

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