Provider Demographics
NPI:1730178096
Name:HANNON, JOSEPH A (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:HANNON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4854 ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3919
Mailing Address - Country:US
Mailing Address - Phone:239-592-7474
Mailing Address - Fax:239-592-7789
Practice Address - Street 1:10621 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7333
Practice Address - Country:US
Practice Address - Phone:239-592-7474
Practice Address - Fax:239-592-7789
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3221213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery