Provider Demographics
NPI:1790725182
Name:HANNEL, JEFFREY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:HANNEL
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 65074
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-5074
Mailing Address - Country:US
Mailing Address - Phone:806-576-3856
Mailing Address - Fax:806-305-3348
Practice Address - Street 1:13810 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-576-3856
Practice Address - Fax:806-305-3348
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122115208Medicaid
TX8V8697OtherBCBS
TX100168106OtherTEAM CHOICE - CORE
TX7195028OtherAETNA
TX100168106OtherFIRSTCARE
TXP00341318OtherMEDCARE RAILROAD
TX7195028OtherAETNA
TX8F3400Medicare PIN
TX5892790001Medicare NSC