Individual
DR. GREGORY RUSSELL HANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3316 W 66TH ST STE 200, EDINA, MN 55435-2544
(952) 303-8600
(952) 920-8899
Mailing address
3316 WEST 66TH ST, #200, EDINA, MN 55435
(952) 920-3808
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
59142
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2013
Last updated
07/21/2022
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