Provider Demographics
NPI:1508251976
Name:HANNA, CAMERON FRASER
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:FRASER
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 N DONAHUE DR APT B14
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4803
Mailing Address - Country:US
Mailing Address - Phone:407-232-1079
Mailing Address - Fax:
Practice Address - Street 1:449 N DONAHUE DR APT B14
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-4803
Practice Address - Country:US
Practice Address - Phone:407-232-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8694521390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program