# ALPHA OMEGA MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1386136315
- **Authorized official:** DR. RAYMON HANNA DPM (PODIATRIST/FOOT AND ANKLE SURGEON)
- **Authorized official phone:** (201) 925-1105

## Contact information

- **Practice address:** 36503 US HIGHWAY 19 N, PALM HARBOR, FL 34684
- **Practice address phone:** (201) 925-1105
- **Mailing address:** 5750 RUSACK DR, MELBOURNE, FL 32940-8016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME131622 | FL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | PO3900 | FL | — |

## Other

- **Enumeration date:** 06/05/2018
- **Last updated:** 06/25/2018