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NPI Code Detail

MEDICARE: MARTIN A HANNON MD

MEDICARE:   MARTIN A HANNON  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
1207Q00000XFamily Medicine PhysicianE3067AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124029624
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN A HANNON MD
Provider Business Mailing Address
First Line : PO BOX 1523
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72702-1523
Country : US
Telephone Number : 479-571-6038
Fax Number : 479-582-0222
Provider Business Practice Location Address
First Line : 3730 S PINNACLE HILLS PKWY STE 2
Second Line :
City : ROGERS
State : AR
Zip : 72758-8897
Country : US
Telephone Number : 479-464-5599
Fax Number : 479-464-5598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 08/12/2024

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Directions to “ MARTIN A HANNON MD” Practice Location

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