Provider Demographics
NPI:1245256361
Name:ABOUHANNA, ANTHONY ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ALAN
Last Name:ABOUHANNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:2814 14TH AVE SE
Practice Address - Street 2:RUSKIN HEALTH CENTER
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-349-7800
Practice Address - Fax:813-349-7861
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL059291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272650500Medicaid
U5091ZMedicare ID - Type Unspecified
I35082Medicare UPIN