Provider Demographics
NPI:1477174985
Name:ASGHAR, HANNAN (MD)
Entity Type:Individual
Prefix:MR
First Name:HANNAN
Middle Name:
Last Name:ASGHAR
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 1:2001 KINGSLEY AVE - GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-639-2005
Mailing Address - Fax:904-639-2015
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-639-2005
Practice Address - Fax:904-639-2015
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2022-06-08
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-06-08
Provider Licenses
StateLicense IDTaxonomies
FLTRN31747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine