Provider Demographics
NPI:1083830715
Name:HANLEY, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:HANLEY
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 1:4411 W GORE BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-699-8383
Mailing Address - Fax:580-699-8381
Practice Address - Street 1:4411 W GORE BLVD STE A2
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-699-8383
Practice Address - Fax:580-699-8381
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26782208VP0014X, 207L00000X
KS6303207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine