Provider Demographics
NPI:1639136245
Name:HANNA, ANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIS
Middle Name:
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 1:3040 N SWAN RD, STE B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1206
Mailing Address - Country:US
Mailing Address - Phone:520-327-3454
Mailing Address - Fax:520-327-3431
Practice Address - Street 1:3040 N SWAN RD, STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1206
Practice Address - Country:US
Practice Address - Phone:520-327-3454
Practice Address - Fax:520-327-3431
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32219207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861452-01Medicaid
AZ861452-01Medicaid
AZZ81096Medicare PIN