Provider Demographics
NPI:1043203706
Name:HAN, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD BOX 100265
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3001
Mailing Address - Country:US
Mailing Address - Phone:352-273-9000
Mailing Address - Fax:352-392-8413
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 550-560
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2781
Practice Address - Country:US
Practice Address - Phone:386-255-2340
Practice Address - Fax:386-258-3284
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39059207T00000X
FLME143543207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200081060AMedicaid
OK244630804Medicare PIN
I14584Medicare UPIN