Provider Demographics
NPI:1093822983
Name:HANNON, GEORGE DUGGAN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DUGGAN
Last Name:HANNON
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 1:12623 E GUARDSMAN PASS RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:UT
Mailing Address - Zip Code:84121-9729
Mailing Address - Country:US
Mailing Address - Phone:435-615-1280
Mailing Address - Fax:
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-993-9551
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT177450-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870280408HA1OtherEDUCATORS MUTUAL
AZ832106Medicaid
UT28154OtherPEHP
UT416936OtherDESERET MUTUAL
UTQM0000049521OtherALTIUS
UT2373OtherHEALTHY U
UT107006884101OtherIHC
MT401765Medicaid
UTPR00872OtherMOLINA
UT2000040OtherUNITED HEALTHCARE
AZ832106Medicaid