Individual
DR. MARK RAYMOND HANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1305 VALENTINE ST, MELBOURNE, FL 32901-3127
(321) 254-7717
(321) 428-4526
Mailing address
PO BOX 361095, MELBOURNE, FL 32936-1095
(321) 254-7717
(321) 428-4526
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME86470
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267063100
—
FL
01
—
P00242439
RR MEDICARE
FL
Enumeration date
02/18/2006
Last updated
07/25/2022
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