Provider Demographics
NPI:1366456089
Name:HANNA, ROBERT SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAMUEL
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 1:5165 GRAND CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9102
Mailing Address - Country:US
Mailing Address - Phone:307-751-8311
Mailing Address - Fax:828-497-1723
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:CALLER BOX C-268
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-5392
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:828-497-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7567A174400000X
CODR.0023020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156996001Medicaid
MO207558107OtherMISSOURI MEDICAID
ARP00196059OtherRAILROAD MEDICARE
ARD24195Medicare UPIN
AR156996001Medicaid