Provider Demographics
NPI:1760500870
Name:RUSSELL L HANAN M D INC
Entity Type:Organization
Organization Name:RUSSELL L HANAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:405-235-3245
Mailing Address - Street 1:400 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3711
Mailing Address - Country:US
Mailing Address - Phone:405-235-3245
Mailing Address - Fax:405-235-6991
Practice Address - Street 1:400 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3711
Practice Address - Country:US
Practice Address - Phone:405-235-3245
Practice Address - Fax:405-235-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty