Provider Demographics
NPI:1922195700
Name:HANRAHAN, JEFFERY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:HANRAHAN
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:PO BOX 840048
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0048
Mailing Address - Country:US
Mailing Address - Phone:806-212-5079
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1751 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1711
Practice Address - Country:US
Practice Address - Phone:806-212-4673
Practice Address - Fax:806-212-0057
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR17672080P0207X, 2080P0207X
CAA80476208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370645905Medicaid
TX1N3895OtherMEDICARE