Individual
LAURENCE GERALD HANELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Mailing address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
27584
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
27584
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005472
GROUP MEDICAID ID
AZ
01
—
1609846922
PHYSICIAN INDIVIDUAL NPI
AZ
01
—
1841261989
GROUP NPI
AZ
01
—
300102513
MEDICARE RAILROAD
AZ
05
—
473835
—
AZ
01
—
CS7943
GROUP MEDICARE RAILROAD ID & PTAN
AZ
01
—
ZWCBBM
GROUP MEDICARE ID
AZ
Enumeration date
01/26/2006
Last updated
01/30/2013
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