Provider Demographics
NPI:1417923855
Name:HANUSA, JAMES JON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JON
Last Name:HANUSA
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 1:2902 59TH ST W
Mailing Address - Street 2:SUITE M
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7023
Mailing Address - Country:US
Mailing Address - Phone:941-795-7401
Mailing Address - Fax:941-795-7414
Practice Address - Street 1:2902 59TH ST W
Practice Address - Street 2:SUITE M
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7023
Practice Address - Country:US
Practice Address - Phone:941-795-7401
Practice Address - Fax:941-795-7414
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275276000Medicaid
WI0000-71064Medicare ID - Type Unspecified
B53399Medicare UPIN
B53399Medicare UPIN