Organization
ARIZONA SURGEONS ASSISTANT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAITHAM M HANNA PA-C (CEO)
(602) 568-7294
Entity
Organization
Contact information
Practice address
4369 E HARTFORD AVE, PHOENIX, AZ 85032-2298
(602) 568-7294
(602) 867-4992
Mailing address
4369 E HARTFORD AVE, PHOENIX, AZ 85032-2298
(602) 568-7294
(602) 867-4992
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1013800
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922
AZ MEDICAL BOARD
AZ
01
—
Z138269
MEDICARE PTAN
AZ
Enumeration date
05/03/2010
Last updated
03/07/2023
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