Provider Demographics
NPI:1518371616
Name:HANNA, RAYMON (DPM)
Entity Type:Individual
Prefix:
First Name:RAYMON
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36503 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1340
Mailing Address - Country:US
Mailing Address - Phone:727-772-0800
Mailing Address - Fax:727-255-5747
Practice Address - Street 1:36503 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1340
Practice Address - Country:US
Practice Address - Phone:727-772-0800
Practice Address - Fax:727-255-5747
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3900213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIY606YOtherMEDICARE IND
FLCZOFMOtherBCBS IND
FLO7PB8OtherBCBS GRP
FL100411400Medicaid
FL2207573OtherWELLCARE
FL100413300OtherMEDICAID GRP
FLJN786OtherMEDICARE GRP