Provider Demographics
NPI:1215038567
Name:HANNA, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-295-1311
Mailing Address - Fax:936-295-1551
Practice Address - Street 1:130 MEDICAL CENTER PARKWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-295-1311
Practice Address - Fax:936-295-1551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE6089207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033077101Medicaid
C16554Medicare UPIN