Provider Demographics
NPI:1770576076
Name:HANAN, MORRIS R (MD)
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:R
Last Name:HANAN
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 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-876-9191
Mailing Address - Fax:813-876-3103
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-876-9191
Practice Address - Fax:813-876-3103
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0036666207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0650008100Medicaid
FLD85515Medicare UPIN
FL30291Medicare ID - Type Unspecified