Provider Demographics
NPI:1124027669
Name:HANNA, GEORGE P (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:HANNA
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-0728
Mailing Address - Country:US
Mailing Address - Phone:979-323-7000
Mailing Address - Fax:979-323-7391
Practice Address - Street 1:104 7TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4853
Practice Address - Country:US
Practice Address - Phone:979-323-7000
Practice Address - Fax:979-323-7391
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2052207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127547101Medicaid
TX127547106Medicaid
TXJ2052OtherSTATE MEDICAL LICENSE
F92615Medicare UPIN
TX00503LMedicare PIN