Individual
JASON ROBERT HANNIBAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4357
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4357
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
60480
CA
363A00000X
Physician Assistant
Primary
7250
CT
Other
Enumeration date
11/04/2020
Last updated
12/17/2025
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