Individual
JASON D HANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01067408A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01067408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000715196
ANTHEM
—
05
—
201029320
—
IN
01
—
P00999004
RAILROAD MEDICARE
—
Enumeration date
02/05/2007
Last updated
11/07/2016
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