Provider Demographics
NPI:1861874489
Name:HANNAM, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:HANNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1407
Mailing Address - Country:US
Mailing Address - Phone:636-622-9050
Mailing Address - Fax:636-622-9060
Practice Address - Street 1:425 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1407
Practice Address - Country:US
Practice Address - Phone:636-622-9050
Practice Address - Fax:636-622-9060
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018002789208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice