Individual
DR. HANI ISSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 PAVILLON PLACE, PENNY FARMS, FL 32079
(904) 388-3351
Mailing address
1907 ATLANTIC BLVD, JACKSONVILLE, FL 32207-3405
(043) 883-3519
(904) 389-3507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125050623
IL
207R00000X
Internal Medicine Physician
ME133628
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME133628
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME133628
MEDICAL LICENSE
FL
Enumeration date
05/14/2008
Last updated
08/27/2021
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