# CASEY HANNA MD PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003099276
- **Authorized official:** BRYAN CASEY HANNA MD (OWNER)
- **Authorized official phone:** (918) 485-5188

## Contact information

- **Practice address:** 1202 W CHEROKEE ST STE E, WAGONER, OK 74467-4629
- **Practice address phone:** (918) 485-5188
- **Practice address fax:** (915) 485-5402
- **Mailing address:** PO BOX 894, WAGONER, OK 74477-0894
- **Mailing address phone:** (918) 485-5188
- **Mailing address fax:** (918) 485-5402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 21947 | OK | Yes |

## Other

- **Enumeration date:** 12/11/2007
- **Last updated:** 07/22/2009