MEDICARE: DR. OLIVER MARTIN HASEK JR. 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	207Q00000X	Family Medicine Physician	61068	FL
2	207L00000X	Anesthesiology Physician	61068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14863	OTHER	FL	BC/BS OF FL
3	61068	OTHER	FL	MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205814589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER MARTIN HASEK JR. MD

Provider Business Mailing Address
First Line	:	7205 THOMAS DR # 1906
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7501
Country	:	US
Telephone Number	:	850-387-6290
Fax Number	:	850-234-7961

Provider Business Practice Location Address
First Line	:	2600 HOSPITAL DR
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-4264
Country	:	US
Telephone Number	:	850-547-8000
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/30/2022

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