MEDICARE: DR. JOSEPH A. HANNON D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3221	FL

General Provider Information

NPI Number	:	1730178096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH A. HANNON D.P.M.

Provider Business Mailing Address
First Line	:	4854 ESPLANADE ST
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3919
Country	:	US
Telephone Number	:	239-592-7474
Fax Number	:	239-592-7789

Provider Business Practice Location Address
First Line	:	10621 AIRPORT PULLING RD N
Second Line	:	SUITE 1
City	:	NAPLES
State	:	FL
Zip	:	34109-7333
Country	:	US
Telephone Number	:	239-592-7474
Fax Number	:	239-592-7789

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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